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.