COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU

Abstract

Background Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases. Methods We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020. Results Of 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of > 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of > 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was > 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality. Conclusions A D-dimer concentration of > 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of > 4 and DIC score of > 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of > 2 mg/L or DIC score of ≥ 5.

Learning to learn by yourself: Unsupervised meta‐learning with self‐knowledge distillation for COVID‐19 diagnosis from pneumonia cases

“…Most patients have an air bronchogram 60 . The distribution characteristics of the abnormalities on X‐ray images about these five types of pneumonia are similar to those of CT images (slices) 52,61‐73 . Although the collected 2D data (e.g., X‐ray images) in our proposed data set misses lots of information (original intensity level, spacing, etc.)…”

“…60 The distribution characteristics of the abnormalities on X-ray images about these five types of pneumonia are similar to those of CT images (slices). 52,[61][62][63][64][65][66][67][68][69][70][71][72][73] Although the collected 2D data (e.g., X-ray images) in our proposed data set misses lots of information (original intensity level, spacing, etc.) than original volume data, considering the usage of our proposed 2D-oriented algorithm, we have tried our best to keep the original size of the images while avoiding the problem of image distortion.…”

Is it sufficient to evaluate COVID‐19 infected critically ill patients only in terms of VTE risk factors? What about disease severity?

“…Third, to determine COVID-19 associated thromboembolism, Sequential Organ Failure Assessment (SOFA) score that is one of the disease severity and organ failure scores has been evaluated by some previous studies. 4,5 These studies suggest that in critically ill COVID-19 patients, higher SOFA scores are associated with higher DVT frequency, D-dimer levels, duration of disease, hypoalbuminemia, and duration of disease. 4 Other previous study 5 reported that higher ISTH SIC scores which include SOFA score, prothrombin time-international normalised ratio (PT-INR), and platelet levels are associated with higher mortality and patients with ISTH SIC score higher than 3 had 3.05-fold increased mortality risk.…”

Associations and prognostic accuracy of electrolyte imbalances in predicting poor COVID-19 outcome: a systematic review and meta-analysis

“…Ten studies investigated the association of hypocalcemia with the same COVID-19 clinical outcomes (Table 1). [23,24,38,45,49,50,53,54,56,57] Majority of the studies defined hypocalcemia as having a serum calcium level of < 2.20 mmol/L, with the exception of one study that defined it as < 1.8 mmol/L. [56] There were no studies that investigated hypercalcemia.…”