Peroxiredoxin 4 Serum Level in Children with Acute COVID 19 Infection and Multisystem Inflammatory Syndrome in Children Related to COVID 19

Abstract

Abstract Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but severe condition that has been observed in pediatric patients following COVID-19 infection. The identification of biomarkers for MIS-C can help early dignosis and appropriate management. Oxidative stress is a phenomenon caused by an imbalance between production and accumulation of oxygen reactive species in cells and tissues and the ability of a biological system to detoxify these reactive products. the peroxiredoxins are a recently identified class of antioxidant enzymes and are more associated with cellular signaling mechanisms during oxidative stress, so we used peroxirodoxin 4 as amarker of oxidative stress that occurred in MISC and COVID 19 infection. Aim To assess the serum level of peroxiredoxin 4 in children with acute covid 19 infection and Multisystem inflammatory syndrome in children related to covid 19 as a biomarker of oxidative stress. Methods This is a cross sectional study that included (87) children recruited consecutively. They were assigned into 3 groups, pediatric patients with COVID-19 (n = 28), Pediatric patients with MIS-C (n = 29) related to COVID-19, as well as healthy controls (n = 25) matching age and gender in both groups. In addition, patients were mainly assessed for detailed history taking, clinical examination, laboratory investigations including complete blood count, C- reactive protein, kidney function tests, liver function tests, electrolytes, coagulation profile, D- dimer, creatine kinase, troponin and serum peroxiredoxin 4 level which assessed by the enzyme linked immunosorbent assay. also serum peroxiredoxin 4 was correlated with symptoms and signs in both covid 19 and MIS-C group. Results we included 28 patients in the Covid-19 group with Median (IQR) age 48 (22.5 – 84) and range (1.4-1.44) months, and 29 patients in the MIS-C group with median (IQR) age 66 (24 – 96) and range (1.3-156) months. We found that the median peroxiredoxin 4 level was significantly higher in the Covid 19 group than the MISC and control groups with median (IQR) (38.5 ng/ml), (23 ng/ml), and (3.9 ng/ml), range (8.30-96.00 ng/ml), (8.37-73.80 ng/ml), and (2.02-8.04 ng/ml) and p value <0.001, 0,023, and <0.001 respectively. As regards vital signs in the two groups, MIS-C patients had significantly higher temperature, and oxygen saturation with (38.45 °C vs. 37.70 °C), and (98.48% vs. 95.32%), respectively. Regarding laboratory investigations, Ferritin and C- reactive protein, MIS-C group had significantly higher values with (489 vs 197 µg/L), and (188, and 38), respectively. As regards correlation between Peroxiredoxin 4 with symptoms in the MIS-C group, peroxiredoxin 4 showed significant positive correlation with extremities changes and as regard laboratory and radiological investigations peroxiredoxin 4 showed significant positive correlation with ESR and chest x rays. Regarding correlation between peroxiredoxin 4 with Covid-19 group, it had positive correlation with ferritin and creatinine levels. Conclusion peroxiredoxin 4 can effectively indicate the occurance of oxidative stress in MISC and COVID 19 infection and distinguish between MISC and COVID19 cases as it is level is higher in COVID 19 than MISC cases.