الفهرس 
CORONAVIRUSESOnly 14 pages are availabe for public view
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Abstract
C
oronavirus disease 2019 (COVID-19) represents a major health emergency worldwide. Early recognition of severe forms is essential to align effective management and treatment strategies. However data on the role of soluble interleukin-2 receptor/lymphocytes ratio in the severity of COVID-19 are very limited.
This observational cross-sectional, single-center study aimed to determine the role of the ratio between sIL-2R concentration and lymphocyte count as an indicator of COVID-19 severity in pediatric patients which may help in predicting the clinical progression of the disease.
The study enrolled 76 pediatric patients with confirmed COVID-19 admitted to Ain Shams University Pediatric Teaching Hospital, Cairo, Egypt, during the period from October 2020 to April 2021. Patients aged from 2 months up to less than 18 years were classified into two groups: group I included 33 (43.4%) patients with mild to moderate manifestations and group II included 43 (56.6%) patients with severe to critical manifestations. The majority of the patients presented with fever (96.1%), while, cough, dyspnea and lower respiratory symptoms were significantly reported among the patients of group II.
Blood samples were collected from the participants and soluble IL-2R concentrations were measured using a commercial enzyme-linked immunosorbent assay.
There was a significant increase in the sIL-2R level in group II in comparison with group I, while there was a significant decrease in lymphocyte count in group II in comparison with group I, sIL-2R/ lymphocyte ratio increased with increased disease severity.
sIL-2R showed a significantly higher discriminative power between patients in both groups (AUC=0.955) as compared to sIL-2R/ lymphocyte (AUC=0.711) and lymphocyte count (AUC=0.549) with (p value<0.0001). sIL-2R showed better performance in predicting the need for supplemental oxygen (AUC=0.904) and the need for intensive care unit admission (AUC=0. 935).
As a result sIL-2R and sIL-2R/lymphocytes can be considered as a prominent biomarkers for early identification of severe patients and predicting the clinical progression of COVID-19.
CONCLUSION
T
he data obtained in this study suggest the potential utility of soluble interleukin-2 receptor (sIL-2R) as a predictive indicator of severity in coronavirus disease 2019 (COVID-19) patients; thus, allowing earlier identification of high-risk patients and those who will be hospitalized for a longer period. Accordingly, this can provide better treatment strategies and clinical decision-making for COVID-19 patients at an early stage.
The present work might serve as a preliminary report for future investigations on a larger scale and with a longitudinal design; to confirm and validate the clinical indications of sIL-2R level in COVID-19 patients.
RECOMMENDATIONS
1. More studies with larger sample size are required for better evaluation of soluble interleukin-2 receptor (sIL-2R) as a prognostic marker in coronavirus disease 2019 (COVID-19).
2. Follow up studies with serial assessment of sIL-2R level are needed since the date of admission and correlating it with clinical state of the patients and relevant laboratory parameters in order to assess sIL-2R as a biomarker for early stratification of COVID-19 patients.
3. The development of new severity classification methods in pediatric patients is necessary.