Diagnostic value of routine blood tests in differentiating between SARS-CoV-2, influenza A, and RSV infections in hospitalized children: a retrospective study

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), influenza A, and respiratory syncytial virus (RSV) infections have similar modes of transmission and clinical symptoms.

There is a need to identify simple diagnostic indicators to distinguish these three infections, particularly for community hospitals and low- and middle-income countries that lack nucleic acid detection kits.

This study used clinical data to assess the diagnostic value of routine blood tests in differentiating between SARS-CoV-2, influenza A, and RSV infections in children.

METHODS: A total of 1420 children treated at the Hangzhou Children’s Hospital between December 2022 and June 2023 were enrolled in this study, of whom 351 had SARS-CoV-2, 671 had influenza, and 398 had RSV.

In addition, 243 healthy children were also collected.

The blood test results of SARS-CoV-2 patients were compared to those of patients with influenza A and RSV and the healthy controls.

The area under the receiver operating characteristic curve (AUC-ROC) was employed to evaluate each blood parameter’s diagnostic value.

RESULTS: Children with SARS-CoV-2 exhibited notably elevated levels of white blood cell (WBC) count, platelet (PLT) count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) compared to influenza A patients (P < 0.05).

In contrast, SARS-CoV-2 patients exhibited a decrease in the mean platelet volume to platelet count ratio (MPV/PLT) and the lymphocyte-to-monocyte ratio (LMR) when compared to other individuals (P < 0.05).

These parameters had an AUC between 0.5 and 0.7.

Compared to patients with RSV, SARS-CoV-2 patients had significantly higher MPV/PLT and significantly lower WBC, lymphocyte, PLT, LMR, and lymphocyte multiplied by platelet (LYM*PLT) values (P < 0.05).

However, only LYM*PLT had an acceptable diagnostic value above 0.7 for all age groups.

Compared to healthy children, children with COVID-19 exhibited elevated NLR and MPV/PLT levels, alongside decreased lymphocyte, PLT, LMR, and LYM*PLT values.

(P < 0.05).

The AUC of the LMR, LYM*PLT, and PLT were above 0.7 in all age groups, indicating promising diagnostic values.

CONCLUSIONS: The routine blood parameters among patients with COVID-19, influenza A, and RSV differ significantly early in the disease and could be used by clinicians to discriminate between the 3 types of infection.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-024-04822-y.