Coagulopathy and clinical outcomes of pediatric cancer patients with COVID-19 infection in Surabaya

Coagulopathy is one of the most common complications presented in children with cancer and COVID-19. Elevated D-dimer levels and hemostatic function (PPT and APTT) are crucial for early identification of severe COVID-19 infections and have been linked to higher mortality rates. It presents a complex clinical challenge, intertwining the prothrombotic and bleeding tendencies of malignancy with the coagulopathic complications induced by the SARS-CoV-2 virus. This study investigated the incidence and implications of coagulopathy with clinical outcomes in pediatric cancer patients with COVID-19 within a tertiary hospital in Surabaya. A retrospective cross-sectional study in Dr. Soetomo General Hospital included children aged <18 years with malignancy and COVID-19 who were hospitalized between June 2020 to August 2022. A multiple binary logistic regression using a backward elimination model was conducted to assess the association between APTT, PPT, D-dimer, platelets, and in-hospital mortality. A total of 40 children diagnosed with cancer tested positive for COVID-19 via qRT-PCR. The majority were male (65%) and aged 2-11 years (75%), and 85% with coagulopathy. Acute lymphoblastic leukemia was the most common cancer (62.5%), followed by acute myeloblastic leukemia (17.5%), Wilm’s tumor (7.5%), and retinoblastoma (5%). Significantly higher leukocyte counts were noted in non-survivors (median 17.25 vs. 5.48; p=0.005). Elevated D-dimer had a 12 times higher risk of mortality in both bivariate and multivariate analyses (OR 12.69; 95% CI [1.44-112.02]; p=0.022 and OR 11.905; 95% CI [1.27-111.68]; p=0.030). Elevated D-dimer levels were correlated with a 12-fold increased risk of in-hospital mortality among pediatric cancer patients with COVID-19.