Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Sep 2018

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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : SC01 - SC06 Full Version

Role of Inflammatory Markers and Clinical Correlate in Children Infected with the Novel SARS-CoV-2: A Prospective Observational Study

Published: January 1, 2023 | DOI:
Amitabh Singh, Shruti Jain, Vikramjeet Dutta, Sumita Saluja, Rajni Gaind, Shobha Sharma

1. Associate Professor, Department of Paediatrics, Vardhman Mahavir Medical Collge and Safdarjung Hospital, New Delhi, Delhi, India. 2. Senior Resident, Department of Paediatrics, Vardhman Mahavir Medical Collge and Safdarjung Hospital, New Delhi, Delhi, India. 3. Associate Professor, Department of Microbiology, Vardhman Mahavir Medical Collge and Safdarjung Hospital, New Delhi, Delhi, India. 4. Professor, Department of Haematology, Vardhman Mahavir Medical Collge and Safdarjung Hospital, New Delhi, Delhi, India. 5. Professor, Department of Microbiology, Vardhman Mahavir Medical Collge and Safdarjung Hospital, New Delhi, Delhi, India. 6. Professor, Department of Paediatrics, Vardhman Mahavir Medical Collge and Safdarjung Hospital, New Delhi, Delhi, India.

Correspondence Address :
Dr. Shobha Sharma,
C-31, Nivedita Kunj, Sector 10, R K Puram, New Delhi, India.


Introduction: Inflammatory markers have been used as predictors of adverse outcomes in adults with Coronavirus Disease-2019 (COVID-19) infection. Children mostly have mild infections and raised inflammatory markers have been reported only with severe COVID-19 or Multisystem Inflammatory Disorder (MIS-C). Studies in children showing the role of inflammatory markers in disease prognosis are few, and findings are not conclusive.

Aim: To find out correlation, if any, between the inflammatory markers {Interleukin-6 (IL-6), C-reactive Protein (CRP), procalcitonin, Pro-B-type natriuretic Peptide (Pro-BNP), ferritin, D-dimer} with clinical presentation, prognosis, and outcome in children with acute COVID-19.

Materials and Methods: The prospective, observational study was conducted at a tertiary care COVID-19 Paediatric Intensive Care Unit {PICU (Vardhaman Medical College and Hospital, New Delhi)}, Northern India, between September 2020 and December 2020. All children aged less than 12 years, with a positive COVID-19 report were enrolled and investigated. Data was collected for clinical presentation, severity, treatment and outcome. The following variables were recorded: Complete Blood Count (CBC), Kidney Function Test (KFT) and Liver function Test (LFT), Absolute Lymphocyte Count (ALC), Absolute Neutrophil Count (ANC), Neutrophil-lymphocyte Ratio (NLR), Platelet Count (PLT), C-reactive Protein (CRP), Procalcitonin (PCT), serum ferritin, Lactate Dehydrogenase (LDH), fibrinogen, and Erythrocyte Sedimentation Rate (ESR) and ProBNP. Coagulation parameters like Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), International Normalised Ration (INR), D-dimer were taken. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0.

Results: A total of 35 children were admitted during the study period. Seventeen children met the criteria for severe disease. Seven children met the criteria for MIS-C. Children presenting with conjunctivitis (n=3) were more likely to have signs of peripheral inflammation hypotension (n=4), tachycardia (n=6), and raised IL-6 levels (pg/mL) as well as the need for inotropic support. IL-6 values were higher in children (Mean±SD= 182.47±149.83). Median IL-6 value 199.8 (96.17-275.24) was highest in children with CRP <10 mg/dL (p-value<0.01). Children with raised D-dimer (Mean±SD=1881.94±1265.66 mg/dL) had a longer duration of stay (p-value=0.031).

Conclusion: The study didn’t find any correlation between inflammatory markers with clinical presentation and the outcome of COVID-19 infection in children.


Coronavirus Disease-2019, Interleukin-6, D-dimer, Severe acute respiratory distress syndrome coronavirus 2, Remdesivir

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections, initially thought to be a respiratory illness, causes a spectrum of multisystem involvement and severity (defined by respiratory failure, septic shock, and multiple organ dysfunction) (1). The overproduction of cytokines caused by aberrant immune activation is known as a cytokine storm and is recognised as a significant cause of disease progression and eventual death (2),(3). The role of Interleukin-6 (IL-6) and, to some extent, IL-10 has been reported as a predictor of COVID-19 severity. Strategies to reduce hypercytokinemia have shown variable results in patients with severe COVID-19. In this respect, IL-6 inhibitors (tocilizumab), anti-Tumour Necrosis Factor (TNF) α (adalimumab), and anti-IL-1beta (anakinra) have been tried clinically (4).

In the pediatric population, most cases of COVID-19 are reported to have a benign course except few with organ system involvement coinciding with a surge of inflammatory markers specifically termed Multisystem Inflammatory Syndrome (MIS-C) (5),(6),(7). Information on the role of inflammatory markers in pediatric COVID-19 is lacking. Most studies of COVID-19 in the pediatric population have focused on clinical manifestations only. There is limited understanding of the full spectrum of disease in children. Suppression of adaptive immunity and hyperimmune response are seen in adults with severe COVID-19 infection (reflected by inflammatory markers). Although children have been treated with anti-inflammatory treatment, including parenteral immunoglobulin and steroids, high mortality is associated with the condition. It is essential to understand this syndrome, its risk factors, and its causality to delineate treatment alternatives better. There is paucity of data regarding cytokine profiles in Indian patients with moderate to severe COVID-19 age group (8),(9),(10). The studies have reported the role of inflammatory markers in multisystem inflammatory syndrome associated with COVID but their role in acute covid -19 infection in children is not well documented. Most data or reports are from North America and Europe, which report COVID-19 to be a milder illness in children so the full spectrum of disease is unknown in low-income to middle-income countries (11).

The aim of the present study was to find out correlation, if any, between the inflammatory markers (IL-6, CRP, procalcitonin, Pro-BNP, ferritin, D-dimer) with clinical presentation, prognosis, and outcome in children with acute COVID-19.

Material and Methods

This hospital-based, prospective cohort study was conducted at a tertiary care COVID-19 Paediatric Intensive Care Unit {PICU (Vardhaman Medical College and Hospital, New Delhi)}, Northern India, between September 2020 and December 2020. Ethical approval was obtained from the Institutional Ethical Committee (S.No. IEC/VMMC/SJH/Project/2020-08/CC-42 dated 28-08-20).

Inclusion criteria: All children under or equal to 12 years infected with SARS-CoV-2 requiring admission between 1st September, 2020 to 31st December, 2020, were included in the study.

Exclusion criteria: Children with post COVID MIS-C or admitted for long COVID manifestation were excluded from the study.

Study Procedure

All children were positive for COVID-19 on nasopharyngeal swab Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test and Cycle Threshold (CT) value was documented for positive children. Severe disease was considered for children with positive RT-PCR or Rapid Antigen Test positive during the current illness, with clinical features of severity (hypotension/shock) and who had need for hospitalisation because of clinical condition. Clinical profile and laboratory investigations were documented for all the children. All participants were investigated with baseline Complete Blood Count (CBC), Kidney Function Test (KFT) and Liver Function Test (LFT), Absolute Lymphocyte Count (ALC), Absolute Neutrophil Count (ANC), Neutrophil-Lymphocyte Ratio (NLR), Platelet Count (PLT), C-Reactive Protein (CRP), Procalcitonin (PCT), serum ferritin, Lactate Dehydrogenase (LDH), fibrinogen, Erythrocyte Sedimentation Rate (ESR) and PRO-B type Natriuretic Peptide (proBNP) and coagulation parameters like Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), International Normalised Ration (INR), D-dimer. Biochemical tests were done using institutional automated analyzers and other markers by Enzyme-linked Immunosorbent Assay (ELISA) kit-based test in the Department of Hematology. Standard institutional protocol for management based on clinical and laboratory parameters was followed in all children. The severity classification was based on World Heath Organisation (WHO) (Clinical management of COVID-19: interim guidance, 27 May 2020) case definition. Clinical features and need for fluid resuscitation, electrolyte management, antibiotics, use of steroids (dexamethasone/methylprednisolone), Intravenous Immune Globulin (IVIG), remdesivir, oxygen support, mechanical ventilation requirement and duration of stay was documented for all the children.

Statistical Analysis

All data were recorded in a predesigned case recording form to facilitate entry in a Microsoft Excel spreadsheet. Categorical variables were analysed by rate, ratio, proportion, and continuous variables by mean {Standard Deviation (SD)}, median {Inter Quartile Range (IQR)}. The association of variables was analysed by Student t-test, Chi-square test wherever applicable. For correlation between two continuous variables: Pearson’s product-moment Correlation (if normally distributed) and Spearman Rank Correlation (if normally distributed) and Spearman Rank Correlation (if not normally distributed) were used. For correlation between a continuous and a categorical variable: Point Biserial Correlation was used. For correlation between two categorical variables: Cramer’s V was used. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0.


A total of 35 children were admitted during the study period. The mean age was 4.61±4 years, of which 11 (31.4%) participants were less than one year of age. Eighteen (51.4%) of the participants were males. Fever was the predominant symptom (97.1%) and rash was present in 8 (22.9%) children. Only a subset (12.9 %) of children were completely asymptomatic. Four children were found to have a culture positive bacterial infection in addition to COVID-19 infection. The summary of the clinical presentation is shown in (Table/Fig 1). Four (11.4%) of the participants had respiratory distress. Three (8.6%) of the participants had a neurological presentation.

The details of lab values are shown in (Table/Fig 2). The mean CT Values were 27.16±5.37. The mean IL-6 Levels (pg/mL) were 182.47±149.83. The mean CRP (mg/L) was 17.52±34.71 and 20 (73.5%) of the participants had CRP ≤10 mg/L. Twenty-six (74.3%) of the participants had ESR: >20 mm/hour and only 3 (8.6%) children were positive for Troponin-T. Nearly 23 percent of the children had serum fibrinogen >400 mg/dL, the majority (65.7%) of the participants had serum procalcitonin ≤0.5 ng/mL and 25 (71.4%) of the participants had LDH >250 mg/dL. Six of the children had TLC <4000/cumm, mean±SD neutrophils was 48.64±19.73%. The mean±SD lymphocytes was 42.47±18.02%. The mean±SD eosinophils (%) was 2.23±1.87 and mean±SD NLR was 1.54±1.10. Eight (22.9%) of the participants had eosinopaenia. Seventeen (48.6%) children had thrombocytopenia. For 10 (28.6%) children urea >30 mg/dL at time of admission, mean±SD serum creatinine was 0.56±1.02 mg/dL and mean±SD sodium was 134.31±6.31 mEq/L.

The mean±SD SGPT (U/L) and SGOT were 66.15±83.54 and 47.29±47.80, respectively. The mean duration of stay was 12.20±5.85 days and 10 (28.6%) of the participants had duration of stay >14 Days. Seven (20%) children received IVIG. Seventeen (48.6%) of the participants were treated with steroids, four (11.4%) children received remdesivir and five (14.3%) participants required Inotrope support and mechanical ventilation

The correlation of laboratory values with clinical features and outcome is shown in (Table/Fig 3). Children presenting with pain abdomen had raised serum urea levels compared to those without pain abdomen (p-value <0.05). Children presenting with respiratory distress were more likely to receive steroids, antiviral, and higher hemodynamic instability chances. Children who required mechanical ventilation were significantly associated (p-value <0.05) with the variable ALP (U/L): SGPT, total bilirubin (mg/dL). Children presenting with conjunctivitis were more likely to have signs of peripheral Inflammation, hypotension, tachycardia, raised IL-6 Levels (pg/mL), need for inotropes. Children with predominantly respiratory symptoms like cough/tachypnea had higher serum procalcitonin (ng/mL), LDH levels. Raised CRP was a surrogate for raised IL-6 Levels (pg/mL), CRP, and raised D-dimer values. Raised D-dimer level correlated with NLR and duration of stay. Children with elevated serum creatinine at presentation had a longer duration of stay. IL-6 was elevated in all children presenting with conjunctivitis. Thrombocytopenia was significantly associated with eosinopenia.


This study didn’t find a single laboratory parameter that correlated with illness severity at admission. IL-6 levels were very high irrespective of clinical presentation in children requiring admission. Elevated D-dimer, pain abdomen and deranged renal function were associated with a prolonged course of illness. CRP correlated with raised IL-6 and D-dimer levels. There was no death in the study group. High CRP values were reported by Graff K et al. as predictors of severe disease in children (12). Elevated CRP has been identified as a risk factor for children requiring critical care. The present study study did not find CRP to be associated with severe illness or ventilatory or inotrope support (13),(14),(15).

In a study by Qiu H et al. from China, higher levels of procalcitonin and creatine kinase-MB (myocardial band), and increased D-dimer levels were reported in mild cases (16). Laboratory data from eight severe paediatric patients from the same country showed normal or increased leucocyte count and high levels of CRP, PCT and LDH (17). In a study of 67 children from the United States, admission to an ICU was associated with higher levels of CRP, procalcitonin, and pro-B-type natriuretic peptide and an increased platelet count (14). Although values of inflammatory markers were high, they did not correlate significantly with the severity of the disease.

Henry BM et al., explained milder disease in children by the absence of lymphopenia (18). Procalcitonin level was increased in 80% of Chinese pediatric patients in the study of Xia and Shao, and, in that series, 40% of the children had a coinfection. The study did find blood culture positive bacterial infection in 4 patients, but their laboratory parameters were not different from those without coinfection (19).

In a meta-analysis on the risk profile of severe illness in children with COVID-19, five clinical characteristics or biomarkers were found to have an independent association with COVID-19 severity (20),(21). The analysis showed 12.9% of children were completely asymptomatic, in agreement with a previous report (22). In the present study, no laboratory markers were consistently associated with severity or outcome of COVID-19.

There was no death in the study group, which is consistent with the findings of other studies. Children tend to have milder diseases (23). Children infected with COVID-19 having an exaggerated inflammatory response against the virus are not commonly described (24),(25).

Similar to the present study, CT values have been reported to be similar in mild and hospitalized children (26). This study found no correlation between CT values and clinical severity or laboratory parameters.

The present study, one of the few prospective studies available from low-income and medium-income countries, points to the need for a clinical symptom-based algorithm for early identification and management of COVID-19 in children.


The small sample size and lack of serial biomarkers are some of the limitations. A large multicentre study to clearly define the role of laboratory markers and appropriate time for repeating the biomarkers is required.


The present study did not find any single laboratory parameters that correlated with the severity of COVID-19 infection in children. As children remain more susceptible to COVID-19 infection due to lack of vaccination, there is a need for a clinical symptom-based algorithm to be implemented especially in a low-resource setting. The majority of children have mild manifestations but elevated inflammatory markers as shown in our study point towards similar pathophysiology of COVID-19 infection in children and adults.


The authors are grateful to Mr. Ashok and Mrs Anita, Senior Technician, Hematology Laboratory, for carrying out the laboratory tests.


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DOI and Others

DOI: 10.7860/JCDR/2023/58491.17247

Date of Submission: Jun 16, 2022
Date of Peer Review: Jul 22, 2022
Date of Acceptance: Oct 01, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jun 28, 2022
• Manual Googling: Sep 19, 2022
• iThenticate Software: Sep 27, 2022 (12%)

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