Assessment and Significance of Pentraxin (PTX3) Plasma Level in Coagulopathy in Children with Covid19

Abstract Background Pentraxin-3 (PTX3), plays an important role in regulation of inflammation and resistance to a lot of pathogens. It has been recently reported to be correlated with coagulopathy and disease severity in patients with COVID-19 Objective To assess significance of PTX 3 as a serum biomarker in children with COVID 19 infection and associated coagulopathy, multisystem inflammatory syndrome in children (MIS-C) and short-term disease outcome. Subjects and Methods This was a cross sectional study, carried out over 6 months duration, from September 1st, 2021, to March 1st, 2022 and it included 62 COVID-19 pediatric patients whose ages ranged between 2 to 18 years admitted through Pediatric Intensive Care Unit or Emergency room and 25 apparently healthy children as a control group. Clinical features, laboratory work up (complete blood picture, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum ferritin and D-dimer) and imaging studies (chest x-ray, computed tomography of the chest (CTscan), echocardiography with calculation of coronary artery Z-score were done to all patients in addition to a measurement of serum PTX3 by enzyme linked immunosorbent assay to both patients and controls. Results The mean (SD) age of the enrolled patients was 8.4±1.71SD. The number of females was 32 and of males was 30. The main presenting symptoms were malaise, sore throat and headache in all patients followed by dry irritative cough (85.5%) and fever (64%). The mean serum PTX3 level was significantly higher in patients compared to controls (13ng/ml (7 – 16.5) versus 0.8ng/ml (0.5 – 1). Serum PTX3 levels were positively correlated with ESR, CRP and serum ferritin as well as with D-dimer (P value=0.007)and INR (P value=0.001). Out of 62 patients, 11 required intensive care unit admission and mortality was 6.5%. PTX3 cut-off level of 8ng/ml had sensitivity of 68.42% and specificity of 100% in predicting significant CT findings categorized as CORAD IV or V. Also PTX3 level with a cut-off of > 2.1ng/ml, has sensitivity of 96.77% and specificity of 100% in detecting the disease severity. Conclusion Our data contribute to the accumulating evidence that PTX3 serum concentrations are significantly elevated in COVID-19 pediatric patients and can serve as an early biomarker of disease severity in children. It can predict significant pulmonary involvement and multi-system inflammatory response. Moreover, PTX3 is likely to participate in COVID-19 associated coagulopathy