Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10516-10528
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10516
Comparison of laboratory parameters, clinical symptoms and clinical outcomes of COVID-19 and influenza in pediatric patients: A systematic review and meta-analysis
Bang Yu, Hai-Hua Chen, Xiao-Fei Hu, Rui-Zhi Mai, Hai-Yan He
Bang Yu, Hai-Hua Chen, Xiao-Fei Hu, Rui-Zhi Mai, Hai-Yan He, Emergency and Critical Care Center, Beijing Jingdu Children’s Hospital, Beijing 102200, China
Author contributions: Yu B and Chen HH conceived and designed the study; Chen HH, Hu XF, Mai RZ and He HY collected the data and performed the analysis; Yu B was involved in the writing of the manuscript and is responsible for the integrity of the study; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The review was reported according to the PRISMA statement 2020.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bang Yu, PhD, Research Scientist, Emergency and Critical Care Center, Beijing Jingdu Children’s Hospital, No. 308 Huilongguan East Main Street, Changping District, Beijing 102200, China. flashmeteor@yeah.net
Received: May 16, 2022
Peer-review started: May 16, 2022
First decision: July 13, 2022
Revised: July 26, 2022
Accepted: August 30, 2022
Article in press: August 30, 2022
Published online: October 16, 2022
Processing time: 136 Days and 4 Hours
Abstract
BACKGROUND

New and more severe clinical manifestations associated with the coronavirus disease 2019 (COVID-19) are emerging constantly in the pediatric age group. Patients in this age group are also primary carriers of the influenza virus and are at a higher risk of developing severe infection. However, studies comparing influenza and COVID-19 to show which condition causes a more severe form of disease amongst the pediatric age group are scarce.

AIM

To compare the laboratory results, clinical symptoms and clinical outcomes in pediatric patients with COVID-19 and influenza.

METHODS

A systematic and comprehensive search was carried out in databases and search engines, including EMBASE, Cochrane, MEDLINE, ScienceDirect and Google Scholar from 1964 until January 2022. A meta-analysis was carried out using a random-effects model and pooled odds ratio (OR) or standardized mean difference (SMD) and 95%CI.

RESULTS

A total of 16 studies satisfied the inclusion criteria. Pediatric COVID-19 patients had a significantly reduced risk of cough (pooled OR = 0.16; 95%CI: 0.09 to 0.27), fever (pooled OR = 0.23; 95%CI: 0.12 to 0.43), and dyspnea (pooled OR = 0.54; 95%CI: 0.33 to 0.88) compared to influenza patients. Furthermore, total hemoglobin levels (pooled SMD = 1.22; 95%CI: 0.29 to 2.14) in COVID-19 patients were significantly higher as compared to pediatric influenza patients. There was no significant difference in symptoms such as sore throat, white blood cell count, platelets, neutrophil and lymphocytes levels, and outcomes like mortality, intensive care unit admission, mechanical ventilation or length of hospital stay.

CONCLUSION

COVID-19 is associated with a significantly lower rate of clinical symptoms and abnormal laboratory indexes compared to influenza in the pediatric age group. However, further longitudinal studies of the outcomes between influenza and COVID-19 pediatric patients are needed.

Keywords: COVID-19; Influenza; Meta-analysis; Pediatrics; SARS-CoV-2

Core Tip: Developing new strategies for prevention, early diagnosis and adequate management of pediatric patients infected with coronavirus disease 2019 (COVID-19) or influenza is crucial. It is still not clear which of these two viruses is more severe in pediatric patients and requires intensive interventions. In addition, co-circulation of influenza and COVID-19 present certain diagnostic and therapeutic difficulties, given the similarities in the clinical features, and may lead to adverse treatment outcomes. Our review is the first attempt to compare the various clinical features, laboratory parameters and outcomes between COVID-19 and influenza pediatric patients. However, longitudinal evidence is required to identify reliable effect sizes and to make evidence-based recommendations for developing interventions in the hospital setting.