الفهرس 
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Abstract
C
oronavirus causes a significant infection that mostly affects the respiratory system of humans. COVID-19 pandemic is considered a scientific, medical, and social challenge. The complexity of SARS-CoV-2 is centered on the unpredictable clinical course of the disease that can rapidly develop, causing severe and deadly complications. The identification of effective laboratory biomarkers able to classify patients based on their risk is important in being able to guarantee prompt treatment.
In order to stratify high-risk patients of COVID-19, scientists urgently require accurate biomarkers related to COVID-19 illness progression. To ensure optimal resource allocation, patients must be immediately classified into risk groups following diagnosis due to the rapid spread of the disease. Understanding viral pathogenetic pathways, as well as cellular and organ damage, is critical to the discovery of new biomarkers. Effective biomarkers would be helpful for screening, clinical management, and prevention of serious complications.
Cardiovascular damage plays a significant role in SARS-CoV-2 patients, according to epidemiological findings, with ischemic heart disease and hypertension among the most common pre-existing comorbidities linked to SARS-CoV-2 mortality. As a result, grouping patients into risk categories for suitable early anticoagulant or fibrinolytic therapy is difficult. According to new predictive indicators of cardiovascular risk, a high plasma level of GDF-15 greatly increases the incidence of cardiovascular injury.
GDF-15 is a stress responsive cytokine that’s mainly expressed in cardiomyocytes, adipocytes, endothelial cells, and vascular smooth muscle cells. It increases during tissue injury and inflammatory states and is associated with cardiovascular diseases such as hypertrophy, heart failure, and endothelial dysfunction. GDF-15 levels are higher in association with cardiovascular diseases and infections. During inflammatory conditions, multiple cell types have been shown to release GDF-15, including endothelial cells, epithelial cells, and vascular smooth muscle. Pulmonary epithelial cells constitute a major source of GDF-15 production, especially during hypoxia or upon exposure to various allergens or pathogens.
Finding reliable biomarkers for COVID-19 disease progression has been a huge challenge since the beginning of the epidemic. GDF-15 has attracted particular interest among the different biomarkers investigated because of its link to both endothelial damage related to SARS-CoV-2 virus and cardio-vascular complications, which have proven to be the leading cause of mortality among COVID-19 patients.
This study is a cross-sectional controlled study, and the main aim of this study was to assess the serum level of GDF-15 and to correlate it with clinical, laboratory and radiological severity of COVID-19 infection in pediatric patients.
The study included 144 children, 72 of them were COVID-19 patients and the other 72 were healthy controls.
The results were:
as regards serum GDF-15 levels there was high statistically significant difference between:
Duration of admission of COVID-19 patients in hospital (≤ 10 days and others > 10 days).
COVID-19 children according to their weight for age Z-score.
ECHO finding abnormalities.
Presence of carditis in ECHO.
Abnormalities in Ejection Fraction of patients.
COVID-19 children with cardiac affection and others without.
COVID-19 children who needed mechanical ventilation and others didn’t need.
COVID-19 children admitted in PICU and others not admitted.
COVID-19 children with comorbidities and others without.
COVID-19 children with different clinical severity grading (mild to moderate, severe, and critically ill).
COVID-19 children with different outcome (survived or died).
The serum level of GDF-15 was positively correlated with: ESR, CRP, LDH, D-dimer, INR, CK-MB, AST, Troponin Ⅰ, and clinical severity grading. It correlated negatively with weight for age Z-score, oxygen saturation at room air, lymphocytes count, platelets count, and Ejection Fraction.
Also, there was no statistically significant difference as regards the serum levels of GDF-15 between:
Different age groups (<1 year, 1-5 years and >5 years).
Sex: Males and females.
General condition (fair, ill, or shocked).
Chest CT findings as GGO and consolidation.
And there was non-significant correlation with heart rate, respiratory rate, TLC, hemoglobin, serum ferritin, ALT, BUN, and creatinine.