Document Type

Conference Proceeding

Publication Date

4-26-2025

Abstract

Background: Alkaline phosphatase (ALP) is composed of several isoenzymes. The measured serum (total) ALP is mostly of bone and liver origin. ALP activity changes with growth and puberty, and its level is affected by age and sex. Abnormal ALP levels have been noted in COVID19 patients but its use as a marker of severity has not been assessed to our knowledge.

Objective: Assess if low serum ALP is a marker of disease severity in acute Pediatric SARS-CoV-2-related illnesses.

Design/Methods: Retrospective observational study of children 0-18 years of age hospitalized at Beaumont Children’s Hospital from 3/1/2020-3/31/2022 with positive PCR for SARS-CoV-2 RNA and/or specific IgG for multisystem inflammatory syndrome associated with COVID19 in children (MISC) who had ALP measured within 24 hours of admission. Normal ALP ranges for our hospital, stratified by age/sex, were used (Table). Excluded were children with conditions associated with abnormal ALP (e.g., metabolic bone or liver/biliary tract disease). Severe disease was defined as: oxygen saturation < 94%, need for oxygen supplementation, and/or PICU admission.

Results: Of 425 children with SARS-CoV-2/MISC during the study period, 15 met exclusion criteria. Another 118 did not have ALP measured in the first 24 hours and 1 had multiple admissions. Others were excluded after chart review, leaving 238 in the final analysis group: 45 MISC, 125 classified as “non-severe”, and 68 as “severe”. Among all groups, 23.9% had low ALP on admission (age/sex-adjusted), 72.3% had normal ALP, and 3.8% had high ALP. Children with MISC were the most likely to have low ALP levels (46.7%), followed by those with severe COVID19 (30.9%). Only 12% of those with non-severe COVID19 had low ALP. The odds ratio (OR) for low ALP among severe vs non-severe disease was 3.81 (P=0.001). This was especially pronounced for those ages 1-9 years (OR 7.90. P=0.008) and 10-12 years (OR 14.50, P=0.002). No sex differences were found. For children 1-9 years with low ALP levels on admission, the mean±SD was 128.12±21.89 and 118.19±23.38 for boys and girls, respectively (lower bound of normal range for age [LB]=156). For those 10-12 years of age, the mean±SD for boys and girls was 104.71±13.33 and 104±24.27, respectively (LB=141).

Conclusion(s): Children with low ALP levels at admission are more likely to have a severe SARS-CoV-2-related acute illness vs those with normal ALP. Limitations include the retrospective nature of the study, lack of initial ALP measurements in ~30%, and absence of follow up ALP values during/after recovery.

Comments

Pediatric Academic Societies Meeting, April 24-28, 2025, Honolulu, HI

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