The role of procalcitonin in early differential diagnosis of suspected children with COVID-19

Background:We aimed to identify clinical features of coronavirus disease 2019 (COVID-19) in children and evaluate the role of procalcitonin in early differential diagnosis. Methods: A retrospective analysis was performed on all suspected pediatric cases. Results: 39 (50.6%) of 77 suspected cases were comfirmed, 4 (5.2%) of them had viral coinfection.Compared with non-COVID-19 group (n=33),COVID-19 confirmed group (n=39) had fewer fever(OR[95% CI]0.467[0.314 to 0.694];P=.000) and symptoms of acute respiratory infection (0.533[0.36 to 0.788];P=.001),more asymptomatic (13.568[1.895 to 96.729];P=.000),and more family cluster infections (5.077[2.224 to 11.591];P=.000),while computed tomography had more positive findings of viral pneumonia (1.822[1.143 to 2.906];P=.008).Age(6.9[3.6 to 10.5] vs 5[2.1 to 7.6];P=.088) and gender were statistically insignificant.Procalcitonin (0.05[0.029 to 0.076] vs 0.103[0.053 to 0.21];P=.000) of COVID-19 alone group (n=35) was significantly reduced.While compared with coinfection group (n=4),procalcitonin (0.05[0.029 to 0.076] vs 0.144[0.109 to 2.26];P=.010) was also reduced.The area under curve of model is 0.834 ([95%CI][0.741 to 0.926];P=.000).Procalcitonin as a differential indicator of COVID-19 alone,its area under curve is 0.809 ([0.710 to 0.909];P=.000). The optimal cut-off value is 0.1 ng/mL,the sensitivity, specificity, positive and negative predictive value of differentiating are 65.9%, 78.6%, 82.9%, and 59.2%,respectively. Conclusions: Asymptoms or mild symptoms,positive computed tomography findings and family cluster infection are the main clinical features of COVID-19 in children.With good performance, procalcitonin can provide an important basis for differentiating COVID-19 alone and other viral infection or viral coinfection. Keywords:children;coronavirus disease 2019;differential diagnosis; procalcitonin; suspected