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

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
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."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
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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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"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.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
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.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
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 : March | Volume : 17 | Issue : 3 | Page : SC18 - SC22 Full Version

Clinical Presentation of COVID-19 and Correlation of Severity with Laboratory Parameters among Children Admitted with Severe Acute Respiratory Infection- An Observational Study

Published: March 1, 2023 | DOI:
T Usha Rani, C Nirmala, Vinodh Kumar Mandala, Maria, Karthik, Rakesh Kotha

1. Professor, Department of Paediatrics, Niloufer Hospital, Hyderabad, Telangana, India. 2. Professor, Department of Paediatrics, Niloufer Hospital, Hyderabad, Telangana, India. 3. Assistant Professor, Department of Paediatrics, Niloufer Hospital, Hyderabad, Telangana, India. 4. Junior Resident, Department of Paediatrics, Niloufer Hospital, Hyderabad, Telangana, India. 5. Junior Resident, Department of Paediatrics, Niloufer Hospital, Hyderabad, Telangana, India. 6. Associate Professor, Department of Neonatology, Niloufer Hospital, Hyderabad, Telangana, India.

Correspondence Address :
Dr. Rakesh Kotha,
Associate Professor, Department of Neonatology, Niloufer Hospital, Hyderabad, Telangana, India.


Introduction: On March, 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In adults it causes mild to severe infections, but in children it usually causes asymptomatic or mild illness. Being a new pandemic, it is prudent to analyse the clinical profile, laboratory parameters and severity interpreters in children to formulate optimal management protocols.

Aim: To determine the clinical and laboratory profile of children hospitalised for Severe Acute Respiratory Infections (SARI) and to evaluate the correlation between clinical severity and laboratory parameters- C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) and thrombocytopenia.

Materials and Methods: The present study was a prospective observational study which was undertaken for the duration of seven months from 1st April to 30th November 2020. The study included children aged 1 month to 12 years with the criteria of SARI and who were Coronavirus Disease-2019 (COVID-19) positive. Test parameters such as Complete Blood Count (CBC), CRP, serum electrolytes and kidney function tests were performed at local laboratory as per standard guidelines. The correlation of laboratory parameters (thrombocytopenia, CRP and NLR) with disease severity was done with Pearson’s Rho correlation coefficient. Chi-square test was used for statistical analysis.

Results: A total of 118 (10.2%) children were tested positive for COVID-19, 71 (60.17%) were boys and 47 (39.83%) were girls. The commonest clinical symptoms were fever and tachypnea. Gastrointestinal symptoms were found in 54 (45.76%) of the cases. Myocarditis and shock were noticed in 10 (8.47%) children. In 25 (59.52%) of severe COVID-19 cases, NLR was >3.5 and 18 (42.86%) had thrombocytopenia. Seventeen children died of the disease with a mortality rate of 14.41%. Platelet count and NLR ratios were significantly correlated with disease severity (p≤0.05).

Conclusion: Markers such as NLR and thrombocytopenia which can be used efficiently to assess the severity even in low resource settings, are relevant to a developing country like India. The ratio of neutrophils to lymphocytes can be used as a prognostic marker in resource-constrained settings.


C-reactive protein, Infections, Paediatrics, Thrombocytopenia, Virus

The SARS-CoV-2 is a virus that causes COVID-19 and has emerged as a deadly pandemic. As per the available surveillance data, children account for upto 5% of cases of the total disease burden that are confirmed in the laboratory (1). Children have a relatively mild disease with SARS-CoV-2 infection and have a better prognosis than adults (2),(3). This is postulated to be because of lesser expression of Angiotensin Converting Enzyme-2 (ACE-2) receptors in the lung and intestinal epithelium, frequent vaccinations and viral infections leading to trained innate immunity in children and absence of associated co-morbidities as in adults (4). There are no clearly defined biomarkers to indicate the severity of infection in children (5). To confirm the diagnosis of COVID-19, nasopharyngeal and oropharyngeal swabs with Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) are required for the detection of SARS-CoV-2 nucleic acids (6).

As it is a new disease, a widespread compilation of the data from centres across the world would help to propagate the knowledge of epidemiology and clinical presentation in children. This would further facilitate establishing optimal management protocols. Research was conducted to understand the laboratory and clinical presentation and the correlation of the severity with laboratory parameters in children who were admitted in a tertiary care centre. Null hypothesis was established with no correlation existing between severity and inflammatory biomarkers. This was the first study conducted in Hyderabad, which was useful for low-resource settings to know the severity of illness and to correlate the clinical severity of COVID-19 with the laboratory parameters (thrombocytopenia, CRP and NLR). Primarily, the study objectives were to understand the clinical manifestations and test parameters of COVID-19 in children with SARI and secondarily to correlate the clinical severity of COVID-19 with the laboratory test parameters NLR, CRP and thrombocytopenia.

Material and Methods

This was a prospective observational study conducted for seven months from April 1, 2020 to November 30, 2020 at Niloufer Hospital, Institute for Women and Children‘s Health, Hyderabad, Telangana, India. Prior to the start of the study, the approval of the Organisational Ethics Committee was obtained (IEC/OMC/M.NO.49 (Acad)/62).

Inclusion criteria: Children aged 1 month to 12 years, hospitalised with SARI and tested for COVID-19 RT-PCR positive were selected for the study.

Exclusion criteria: Neonates, children with congenital respiratory track infections, other co-morbidities like asthma, cardiac cases and other bacterial and viral pneumonia cases were excluded from the study.

Sample size calculation: Sample size was calculated as 118 using the below formula. At 95% confidence interval, Z value was 1.96, precision was taken 5% and p-value was 8% (7).


Putting the values into formula, n=(1.96)2 0.08 (1-0.08)/(0.05)2
n=113, 5% drop-out rate was added and 118 cases were finally taken into study.

The structured proforma was designed by the Head of the Paediatric Department, who was not included in the research study to avoid any bias. Data was collected which included demographic data, symptoms, examination findings, and associated co-morbidities. Categorisation of the cases was done as per National Institutes of Health (NIH) 2019 Guidelines for COVID-19 (3). All cases that met the SARI definition were admitted to the isolation wing and tested for COVID-19. Children who were tested positive received treatment according to the standard protocol of COVID Ward. Test parameters such as CBC, CRP, serum electrolytes and kidney function tests were performed at local laboratory as per standard guidelines. According to WHO (2020), SARI is defined as an acute respiratory infection with a history of fever or a measured fever of 38°C or higher, cough or sore throat, difficulty breathing, onset within the last 10 days, and requires hospitalisation (3). The data was entered in a pre-designed proforma [PROFORMA].

Statistical Analysis

Statistical analysis of the data was performed using Statistical Package for the Social Sciences (SPSS) version 25.0. Analysis was done using frequency tables and ratios, and continuous data was presented in terms of mean±standard deviation. The categorical data was presented in the form of a frequency distribution table. The correlation of clinical and laboratory parameters with disease severity was done with Pearson’s Rho correlation coefficient. The p-value <0.05 was considered to be statistically significant.


During the study duration, 1156 children were admitted with SARI. Among them, 118 children tested positive for COVID RT-PCR accounting for 10.2% of the cases. The mean±SD age of presentation was 3.3±3.72 years.

Out of the total 118 cases, 71 (60.17%) were boys, and 47 (39.83%) were girls. Among them, 55% of the children were under the age of one year. Out of the 118 cases, 77 (65.25%) cases were from rural areas. Analysis of the nutritional status by weight for age showed that 33 (27.07%) of the children were falling below the 3rd centile, and 53 (44.92%) of the children were between the 3rd and 50th centile (Table/Fig 1).

All the study cases had tachypnea and fever at the time of admission. The predominant presenting symptom was fever, tachypnea, followed by gastrointestinal symptoms. Seizures were seen in 16.1% of children at the time of presentation (Table/Fig 2). Throat pain (89%), headache (60%), nasal discharge (65%), sneezing (43%), muscle aches (84%) and generalised weakness (90%) were the other features noticed.

Oxygen saturation was checked for at admission in all the children. On presentation, 43 (36.44%) of the COVID-19 cases had SpO2 >95%, 30 (25.42%) had SpO2 of 85-89%, and 12 (10.17%) cases had SpO2 <85%. A total of 75 children (63.55%) were presented with severe COVID-19 with SpO2 of <90%, having severe retractions, grunting, lethargy, and seizures (Table/Fig 3). Myocarditis and shock were noticed in 10 (8.47%) children, in addition to severe pneumonia. Co-morbidities like congenital heart disease, nephrotic syndrome, and cerebral palsy were present in 18 (15.25%) of the cases.

Analysis of the laboratory parameters had shown that 52 (44.07%) of the children with COVID-19 had anaemia, 5 (4.24%) had leukopenia, and 34 (28.81%) had more than 15000 total leucocyte count. Platelet count was normal in 70 (59.32%) children, thrombocytopenia was seen in 25 (21.19%), and thrombocytosis was noticed in 23 (19.49%) children. Prerenal Acute Kidney Injury (AKI) was observed among 14 (11.86%) children. In 7 (5.93%) children, the serum creatinine was >1 mg/dL. Electrolyte disturbances were observed in a significant number of them, with hyponatremia in 30 (25.42%), hypokalemia in 16 (13.56%), and hyperkalemia in 9 (7.63%) cases, respectively (Table/Fig 4).

Among the study population, 45 (38.14%) had NLR of >3.5, while 73 (61.86%) cases had NLR <3.5. NLR of >3.5 was seen in 25 (59.52%) of severe COVID-19 cases compared to 20 (26.31%) of non severe COVID-19 cases, which was statistically significant (z score- 2.3075, p-value- 0.0002) (Table/Fig 5). Pearson coefficient of correlation was r=0.977 with a p-value <0.00001.

CRP was elevated in 82 (69.49%) of the cases. CRP was positive in 28 (66.67%) of cases with severe COVID-19, compared to 54 (71.05%) in non severe cases (z score- 2.8045, p-value- 0.31 and r=0.541) (Table/Fig 6). However, quantitative CRP could not be done due to resource constraints.

Thrombocytopenia was observed in 18 (42.86%) of severe COVID-19 as compared to 9 (11.84%) of non severe cases (p- 0.0005). Pearson coefficient of correlation for severity and thrombocytopenia was r=0.871 with p-value <0.0005 (Table/Fig 7). Around 17 (60.7%) of the cases, who presented with raised CRP were under the age of one year.

Association of the lab parameters (platelet count and NLR) with COVID-19 severity: The laboratory parameters were correlated with the disease severity, out of which, platelet count and NLR showed a statistically significant positive correlation with severe COVID-19 with p-values of less than 0.05 (r=0.871), and 0.00029 (r=0.977), respectively.

Of the total 118 cases, 101 (85.5%) children were discharged and 17 (14.41%) children died. Out of these 17 children, 10 (58.82%) were under the age of one year and 8 (57.14%), had an NLR of >3.5.


Early in the pandemic, there were few reported cases of COVID-19 in children, but as the time passed, more cases were identified. Little is known about this disease, which has a wide range of clinical manifestations, from asymptomatic to fatal. Despite the few reported deaths in otherwise healthy children, it is reassuring that children have a relatively smooth course of the disease in comparison to adults. Investigators collected the data in 2020 when novel paediatric and neonatal cases were noticed in developing countries.

The present study was performed to verify the clinical presentation, and the correlation between disease severity and laboratory parameters in hospitalised children. In the present study, among 1156 children admitted with SARI during the study period, 118 (10.2%) cases tested positive for COVID-19. The mean age of presentation was 3.3±3.72 years, which was comparable to those of Dong Y et al., and Wei M et al., (6),(8), whereas the mean age was higher (6.7 years) in the study by Lu X et al., (9). Infants were more affected in this study, accounting for 55% of cases and a higher proportion of severe COVID-19 cases. Male preponderance was observed in the present study similar to that of Dong Y et al., and Wei M et al., (6),(8). In the current study, 27.97% of children were malnourished at weights below the 3rd percentile. The most common symptom observed in this study were fever (100%) and tachypnea (100%), followed by cough (50.84%) and stomach ache (45.76%). similar to those of Jiehao C et al., and de Souza TH et al., (10),(11).

In the present study, 52 (44.07%) of the children with COVID-19 had anaemia, 5 (4.24%) children had reduced leukocyte counts and 25 (21.19%) had thrombocytopenia. Normal leucocyte counts were observed in 79 (66.95%) children, comparable to the study done by Henry BM et al., and where they found in 69.6% of paediatric cases (12).

Thrombocytopenia was observed in 18 (42.86%) cases of severe COVID-19 as compared to 9 (11.84%) cases of non severe cases. The correlation between thrombocytopenia and disease severity was found to be statistically significant, similar to a study by Bashash D et al., (13). This meta-analysis revealed that non severe cases have a significantly higher number of platelets and showed that the probability of the emergence of thrombocytopenia is significantly higher in the severe cases with the pooled mean difference of -21.5 (%95 CI: -31.57, -11.43).

A NLR >3.5 was observed in 45 (38.14%) children and its correlation with disease severity was statistically significant in present study. A meta-analysis done by Lagunas-Rangel FA where patients with COVID-19 who had severe disease were found to have significantly higher NLR values (SMD=2.404, 95% CI=0.98-3.82) (14). The study done by Sarangi B et al., showed good correlation (r=0.35, p=0.01) (15).

In the present study, raised CRP was found in 82 (69.49%) children a minimal prevalence of increased CRP when compared to that in adults, suggesting a comparatively milder immunological response in children and less immune damage (16). CRP was positive in 54 (71.05%) of the non severe cases, and its correlation with severity was not statistically significant, similar to a study by Saleh NY et al., and Chen L et al., (17),(18). This may be because of the lower sample size in both studies. The current study’s mortality rate was 14.41% because there was a greater proportion of severe cases compared to other studies where mortality was low due to a greater proportion of less severe cases, 1.4% in Guan WJ et al., study and 5.6% in Sena GR et al., study (19),(20).


This study was conducted in a tertiary care facility where the incidence of COVID-19 in children could not be calculated because only cases with dyspnea needed to be hospitalised. The duration and sample size of the study was limited. The correlation of other inflammatory markers such as ferritin, D-Dimer, and IL-6 levels with disease severity could not be done due to resource constraints. Quantitative CRP could not be done due to resource constraints.


In the present study, the predominant presenting symptom was fever (100%) and tachypnea (100%). About 44.07% children with COVID-19 had anaemia. Thrombocytopenia was seen in 21.18% and 38.13% had NLR of >3.5. Platelet count and NLR showed a statistically significant positive correlation with severe COVID-19. Markers such as NLR and thrombocytopenia which can be used efficiently to assess the severity even in low resource settings are relevant to a developing country. NLR and thrombocytopenia markers are helpful in early referral. The ratio of neutrophils to lymphocytes can be used as a prognostic marker in resource-constrained settings. More research is required to establish low-cost precise early inflammatory markers to estimate severity for prompt referral.


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DOI and Others

DOI: 10.7860/JCDR/2023/58535.17567

Date of Submission: Jun 18, 2022
Date of Peer Review: Jul 27, 2022
Date of Acceptance: Feb 18, 2023
Date of Publishing: Mar 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. Yes

• Plagiarism X-checker: Jun 22, 2022
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