Analysis of influencing factors of shortened time of viral nucleic acid negative conversion in mild and common COVID-19 children infected with Omicron variant strain

doi:10.3877/cma.j.issn.1673-5250.2022.06.008

Objective

To investigate the clinical features of mild and common corona virus disease 2019 (COVID-19) children infected with Omicron variant, and influencing factor of shortened time of nucleic acid negative conversion.

Methods

A total of 150 mild and common COVID-19 children infected with Omicron variant in the " parent-child ward" of the southern area of Renji Hospital, School of Medicine, Shanghai Jiao Tong University from April 7 to May 20, 2022 were selected as research subjects. According to the median time of nucleic acid negative conversion (13 d), these 150 children were included in fast turning negative group (n=84, time of nucleic acid negative conversion <13 d) and slow turning negative group (n=66, time of nucleic acid negative conversion ≥13 d). Independent-samples t test, Mann-Whitney U test or chi-square test were performed for comparison between two groups, such as age, gender, composition ratio of mild and common COVID-19, vaccination rate, clinical manifestations related to COVID-19, and systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) within 48 h of COVID-19 onset. Analysis of influencing factors of shortened time of nucleic acid negative conversion in mild and common COVID-19 children infected with Omicron variant was conducted by multivariate unconditional logistic regression analysis. There was no statistically significant difference between two groups in the proportion of children with basic diseases and the rate of symptomatic treatment (P>0.05). The procedures followed in this study were in accordance with the Helsinki Declaration of the World Medical Association revised in 2013.

Results

①The age, proportion of female children, proportion of children with common type of COVID-19, vaccination rate, incidence of fever, sore throat and gastrointestinal symptoms in fast turning negative group were significantly higher than those in slow turning negative group, while the heat peak and incidence of muscle soreness were significantly lower than those in slow turning negative group, and all the differences were statistically significant (P<0.05). ②Multivariate unconditional logistic regression analysis showed that sore throat and vaccination were independent protective factors for shortened time of nucleic acid negative conversion of mild and common COVID-19 children (OR=14.609, 7.866; 95%CI: 1.108-192.697, 1.313-47.121; P=0.042, 0.024), while with muscle pain and male children were its independent risk factors (OR=0.275, 0.206; 95%CI: 0.087-0.874, 0.083-0.511; P=0.029, 0.001). ③The SII of children in fast turning negative group was 250.9×10⁹/L (111.1×10⁹/L, 466.9×10⁹/L), NLR was 1.0 (0.6, 2.2), which both were significantly higher than 109.8×10⁹/L (47.2×10⁹/L, 266.7×10⁹/L) and 0.5 (0.2, 1.2) respectively in slowly turning negative group, and the differences were statistically significant (Z=6.48, 5.34; P=0.011, 0.021). The LMR in fast negative group was 4.1 (2.5, 9.4), which was significantly lower than that 8.2 (3.4, 11.1) of slow negative group, and the difference was statistically significant (Z=4.50, P=0.034).

Conclusions

The symptoms of children with mild and common COVID-19 are not typical, mainly with fever and cough. Children with high SII, NLR, and low LMR have a shorter time of nucleic acid negative conversion of Omicron variant. Vaccination with vaccine, and accompanied by sore throat are protective factors to promote the nucleic acid negative conversion of Omicron variant. While muscle soreness and boys are relative risk factors affecting the time of nucleic acid negative conversion of Omicron variant.

Key words: SARS-CoV-2, COVID-19, Vaccination, Omicron variant, Viral, nucleic acid negative conversion, Peripheral blood parameter ratios, Child

表1 2组轻型与普通型COVID-19患儿临床表现及接种疫苗情况比较

组别	例数	年龄[岁，M(Q₁，Q₃)]	性别[例数(%)]		COVID-19类型[例数(%)]		接种疫苗[例数(%)]	基础疾病[例数(%)]
组别	例数	年龄[岁，M(Q₁，Q₃)]	男	女	轻型	普通型	接种疫苗[例数(%)]	基础疾病[例数(%)]
快转阴组	84	4.2(1.9，7.6)	41(48.8)	43(51.2)	58(69.0)	26(31.0)	32(38.1)	6(7.1)
慢转阴组	66	1.5(0.5，3.4)	43(65.2)	23(34.8)	64(96.9)	2(3.1)	3(4.5)	5(7.6)
统计量		Z＝－5.03	χ²＝4.01		χ²＝18.98		χ²＝23.26	χ²＝0.01
P值		<0.001	0.045		<0.001		<0.001	0.920
组别	例数	发热[例数(%)]	热峰(℃，±s)	咳嗽[例数(%)]	咽痛[例数(%)]	胃肠道症状[例数(%)]	肌肉酸痛[例数(%)]	纳差[例数(%)]
快转阴组	84	76(90.5)	38.7±0.9	36(42.9)	12(14.3)	21(25.0)	10(11.9)	23(27.4)
慢转阴组	66	57(86.4)	39.0±0.9	32(48.4)	3(4.8)	7(10.6)	18(27.3)	19(28.8)
统计量		χ²＝0.62	t＝5.70	χ²＝0.47	χ²＝3.90	χ²＝5.04	χ²＝5.75	χ²＝0.04
P值		0.430	0.017	0.492	0.048	0.025	0.017	0.850

表1 2组轻型与普通型COVID-19患儿临床表现及接种疫苗情况比较

组别	例数	年龄[岁，M(Q₁，Q₃)]	性别[例数(%)]		COVID-19类型[例数(%)]		接种疫苗[例数(%)]	基础疾病[例数(%)]
组别	例数	年龄[岁，M(Q₁，Q₃)]	男	女	轻型	普通型	接种疫苗[例数(%)]	基础疾病[例数(%)]
快转阴组	84	4.2(1.9，7.6)	41(48.8)	43(51.2)	58(69.0)	26(31.0)	32(38.1)	6(7.1)
慢转阴组	66	1.5(0.5，3.4)	43(65.2)	23(34.8)	64(96.9)	2(3.1)	3(4.5)	5(7.6)
统计量		Z＝－5.03	χ²＝4.01		χ²＝18.98		χ²＝23.26	χ²＝0.01
P值		<0.001	0.045		<0.001		<0.001	0.920
组别	例数	发热[例数(%)]	热峰(℃，±s)	咳嗽[例数(%)]	咽痛[例数(%)]	胃肠道症状[例数(%)]	肌肉酸痛[例数(%)]	纳差[例数(%)]
快转阴组	84	76(90.5)	38.7±0.9	36(42.9)	12(14.3)	21(25.0)	10(11.9)	23(27.4)
慢转阴组	66	57(86.4)	39.0±0.9	32(48.4)	3(4.8)	7(10.6)	18(27.3)	19(28.8)
统计量		χ²＝0.62	t＝5.70	χ²＝0.47	χ²＝3.90	χ²＝5.04	χ²＝5.75	χ²＝0.04
P值		0.430	0.017	0.492	0.048	0.025	0.017	0.850

表2 影响轻型与普通型COVID-19患儿核酸转阴时间缩短因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
发热	0.656	1.045	0.394	0.530	1.927	0.248~14.945
咳嗽	－0.478	0.423	1.280	0.258	0.620	0.271~1.420
咽痛	2.682	1.316	4.152	0.042	14.609	1.108~192.697
胃肠道症状	－0.876	0.894	0.961	0.327	0.416	0.072~2.401
肌肉酸痛	－1.290	0.589	4.790	0.029	0.275	0.087~0.874
纳差	1.006	0.515	3.814	0.051	2.733	0.996~7.498
接种疫苗	2.062	0.913	5.099	0.024	7.866	1.313~47.121
年龄	－0.194	0.146	1.747	0.186	0.824	0.618~1.098
热峰	0.735	0.394	3.483	0.062	2.085	0.964~4.510
男性患儿	－1.579	0.463	11.612	0.001	0.206	0.083~0.511
轻型COVID-19	－1.721	1.305	1.739	0.187	0.179	0.014~2.309
常数项	－30.611	17.917	2.919	0.088	0	—

表2 影响轻型与普通型COVID-19患儿核酸转阴时间缩短因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
发热	0.656	1.045	0.394	0.530	1.927	0.248~14.945
咳嗽	－0.478	0.423	1.280	0.258	0.620	0.271~1.420
咽痛	2.682	1.316	4.152	0.042	14.609	1.108~192.697
胃肠道症状	－0.876	0.894	0.961	0.327	0.416	0.072~2.401
肌肉酸痛	－1.290	0.589	4.790	0.029	0.275	0.087~0.874
纳差	1.006	0.515	3.814	0.051	2.733	0.996~7.498
接种疫苗	2.062	0.913	5.099	0.024	7.866	1.313~47.121
年龄	－0.194	0.146	1.747	0.186	0.824	0.618~1.098
热峰	0.735	0.394	3.483	0.062	2.085	0.964~4.510
男性患儿	－1.579	0.463	11.612	0.001	0.206	0.083~0.511
轻型COVID-19	－1.721	1.305	1.739	0.187	0.179	0.014~2.309
常数项	－30.611	17.917	2.919	0.088	0	—

表3 2组轻型与普通型COVID-19患儿SII、NLR、LMR、PLR比较[M(Q₁，Q₃)]

组别	例数^a	SII(×10⁹/L)	NLR	LMR	PLR
快转阴组	40	250.9(111.1，466.9)	1.0(0.6，2.2)	4.1(2.5，9.4)	92.6(59.4，145.8)
慢转阴组	50	109.8(47.2，266.7)	0.5(0.2，1.2)	8.2(3.4，11.1)	68.8(48.2，95.3)
Z值		6.48	5.34	4.50	2.88
P值		0.011	0.021	0.034	0.090

表3 2组轻型与普通型COVID-19患儿SII、NLR、LMR、PLR比较[M(Q₁，Q₃)]

组别	例数^a	SII(×10⁹/L)	NLR	LMR	PLR
快转阴组	40	250.9(111.1，466.9)	1.0(0.6，2.2)	4.1(2.5，9.4)	92.6(59.4，145.8)
慢转阴组	50	109.8(47.2，266.7)	0.5(0.2，1.2)	8.2(3.4，11.1)	68.8(48.2，95.3)
Z值		6.48	5.34	4.50	2.88
P值		0.011	0.021	0.034	0.090

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