ELEVATED SERUM AMYLOID A LEVEL PREDICTS SEVERITY OF RADIOLOGICAL LUNG INVOLVEMENT IN HOSPITALIZED CHILDREN WITH COVID-19

: Background: Several biomarkers were studied in COVID-19 for risk stratification and monitoring disease progression. Aim of the work: We aimed to investigate the dynamics of serum amyloid A in children hospitalized with confirmed SARS-CoV-2 infection. Also, correlations with clinical presentation, disease severity score, radiological lung involvement, and outcome were studied. Patients and Methods: This controlled cross-sectional study included 60 participants divided into 2 equal groups of patients and controls. Thirty children with confirmed COVID-19 diagnosis were recruited from the Pediatric department, Children’s Hospital, Ain Shams University, from October 2020 to March 2021. Thirty age and sex-matched healthy children served as controls. Amyloid A was estimated in serum on admission (Day 1) and 10 days after treatment using ELISA method. Chest computed tomography was performed for all patients on admission. Results: At presentation, serum amyloid A was significantly higher in patients (median (IQR)= 420 (300-600)) compared to controls (median (IQR)= 50 (40-70)) (p<0.001). A cut-off value> 100 ug/ml discriminated patients from controls with 100 % sensitivity and specificity, area under the curve =1, p<0.0001. Serum amyloid A was significantly higher in patients with respiratory distress (p=0), hypoxia (p=0.003), hypotension (p=0.02), and abnormal radiological findings (p=0.03). Comparing COVID-19 severity grades, serum amyloid A was significantly higher among severe and critically ill patients (p=0.001). Serum amyloid A positively correlated with the number of affected lung lobes (r=0.46, p=0.01) and radiological severity score 9r=0.51, p=0.004). Follow-up serum amyloid A level significantly declined compared to day 1 (p=0.001). However, non-survivors showed a significant increase in serum amyloid A level (median (IQR)= 930 (840-1020)) (p=0.01). Conclusions: Serum amyloid A is a useful biomarker for severity and prognosis in children with COVID-19. Also, it can reflect severity of radiological lung involvement.