Serum homocysteine level in pediatric patients with COVID-19 and its correlation with the disease severity

Abstract

Background: Thrombosis and embolism are possible complications in coronavirus disease 2019 (COVID)-19-positive pediatric patients. Although the risk is lesser in children than it is in adults, it does exist during acute infection and multi-inflammatory syndrome in children. Biomarkers such asd-dimer, prothrombin time, and fibrinogen degradation products are ineffective at detecting disease severity. Homocysteine (Hcy) is a prothrombotic factor that has been reported to be higher in adult COVID-19 patients, leading to speculation that it could be used as a biomarker for disease severity. Purpose: To detect the correlation between serum total homocysteine (tHcy) level and the severity of COVID-19 in pediatrics. Methods: A cross-sectional study was conducted on 40 children with COVID-19 and 40 healthy control subjects. Serum tHcy was measured by enzyme-linked immunosorbent assay and correlated with the clinical, laboratory, and radiological parameters of the patients. Results: The median serum tHcy level in COVID-19 patients was 27.5 (interquartile range [IQR]: 23–31.75) μmol/L, while that in the controls was 1.8 (IQR: 1.6–1.875) μmol/L. There was a statistically significant increase in the tHcy level in cases compared to controls (p < 0.001). There was a statistically significant positive correlation between serum tHcy and d-dimer, ferritin, alanine transaminase, aspartate transaminase, blood urea nitrogen, and a highly significant positive correlation between tHcy and COVID-19 reporting and data system score, pediatric intensive care unit admission, and the disease severity classification. Conclusion: Hcy could be a biomarker of importance in predicting the severity of COVID-19 in pediatrics.