SARS-CoV-2 May Damage Blood Vessels in Children, finds Study
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Most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or minimal disease, with a small proportion developing severe disease or multisystem inflammatory syndrome in children (MIS-C). Complement-mediated thrombotic microangiopathy (TMA) has been associated with SARS-CoV-2 infection in adults but has not been studied in the pediatric population. Researchers hypothesized that complement activation plays an important role in SARS-CoV-2 infection in children and sought to understand if TMA was present in these patients.

They enrolled 50 hospitalized pediatric patients with acute SARS-CoV-2 infection (n = 21, minimal coronavirus disease; n = 11, severe COVID-19) or MIS-C (n = 18).
--As a biomarker of complement activation and TMA, soluble C5b9 (sC5b9, normal 247 ng/mL) was measured in plasma, and elevations were found in patients with minimal disease (median, 392 ng/mL), severe disease (median, 646 ng/ml), and MIS-C (median, 630 ng/mL) compared with 26 healthy control subjects (median, 57 ng/mL).
--Higher sC5b9 levels were associated with higher serum creatinine but not age.

Elevations in sC5b9 were significantly correlated with maximum creatinine and blood urea nitrogen levels, and were higher in patients with acute kidney injury. And there was evidence of acute kidney injury in 10% of patients with minimal COVID-19, 36% with severe COVID-19, and 28% with MIS-C.

Researchers were able to obtain peripheral blood smears for 34 patients. They found schistocytes, another indication of TMA, in 45% of patients with minimal COVID-19, 87% with severe COVID-19, and 87% with MIS-C.

Of the 19 patients for whom complete clinical criteria were available, 17 (89%) met criteria for TMA. Elevations in sC5b9 occur independently of other laboratory markers associated with COVID-19 and MIS-C, and are associated with evidence of renal dysfunction. A high proportion of tested children with SARS-CoV-2 infection had evidence of complement activation and met clinical and diagnostic criteria for TMA.