COVID-19 Associated Hepatitis in Children (CAH-C) during the second wave of SARS-CoV-2 infections in Central India: Is it a complication or transient phenomenon
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Abstract
Objective
While pediatric population has largely remained free of severe COVID-19, in some cases SARS-CoV-2 infection has been associated with complications like Multiple Inflammatory Syndrome in children (MIS-C). We mention another unique presentation subsequent to asymptomatic infection of SARS-CoV-2, a unique form of hepatitis designated by us as COVID-19 Associated Hepatitis in Children (CAH-C). The contrasting clinical presentations, temporal association and viral parameters of CAH-C cases, to the MIS-C cases are presented here.
Methods
As a retrospective and follow-up observational study we reviewed all children testing positive for SARS-CoV-2 during study period. Children presenting with “sudden onset of hepatitis, elevated transaminases, non-obstructive jaundice, lacking marked inflammatory responses and without evidence of (a) other known causes of acute hepatitis or previous underlying liver disease (b) multi-system involvement” were classified as CAH-C, are described here.
Results
Among 475 children tested positive, 47 patients presented with hepatitis, 37 patients had features of CAH-C, having symptoms of hepatitis only, with un-elevated inflammatory markers and uneventful recovery following supportive treatment. Whereas remaining 10 MIS-C hepatitis had protracted illness, multiple system involvement, required admission to critical care, and had mortality of 30%.
Conclusion
With the emergence of newer variants of concern (VOC) including the Delta variant which predominated the second wave of infections in India and has now spread to more than 142 countries with changing presentations, CAH-C might be one of them. Cases of such new entities need to be identified early and differentiated from other emerging syndromes in children during the ongoing pandemic for preventing adversities by timely intervention.
Conflicts of interest
The authors declare that they have no conflicts of interest related to the study or its findings. All authors have contributed to the conceptualization and manuscript writing of the study, the final version is approved by all the authors. We declare there are no competing interests involved among the authors.
Funding and ethics approval
Current research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The follow-up and analysis work was performed after obtaining due approval of human ethics committee of the institution (Ref no. IEC/BMC/80/21).
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SciScore for 10.1101/2021.07.23.21260716: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethics approval: The follow-up and analysis work was performed after obtaining due approval of the institution human ethics committee. Sex as a biological variable The chi-square test was performed to check out possible associations between the categorical variables like association of male sex, clinical outcome with either of entities. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The statistical analysis was performed using SPSS trial version 16 for windows. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are …
SciScore for 10.1101/2021.07.23.21260716: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethics approval: The follow-up and analysis work was performed after obtaining due approval of the institution human ethics committee. Sex as a biological variable The chi-square test was performed to check out possible associations between the categorical variables like association of male sex, clinical outcome with either of entities. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The statistical analysis was performed using SPSS trial version 16 for windows. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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