Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York: Observational Cohort

Abstract

ImportanceCOVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020.ObjectiveTo investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death.DesignRetrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020.SettingMontefiore Health System main hospital, Moses, a large tertiary care center in the Bronx.ParticipantsAdult inpatients with positive COVID tests hospitalized at MHS.Exposure (for observational studies)Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data.Main Outcome and MeasuresRelationship and predictive value of measured parameters to mortality and illness severity.ResultsOf the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged).ConclusionWe describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.

Effect of Anticoagulant Administration on the Mortality of Hospitalized Patients With COVID-19: An Updated Systematic Review and Meta-Analysis

“…Of the remaining 47 studies, 36 were excluded after reviewing the full-text manuscript (10 used direct oral anticoagulants as a control group, eight did not compare the mortality of COVID patients receiving anticoagulation with those not receiving anticoagulation directly, 12 enrolled outpatients, and six did not have insufficient outcome data or baseline data for further meta-analysis). A total of 11 observational studies reporting the effect of anticoagulants on mortality ( 9 – 11 , 23 – 30 ) ( n = 11) and bleeding events ( 9 , 25 , 27 – 29 ) ( n = 5) in hospitalized patients with COVID-19 were included in the review.…”

“…All studies were retrospective in study design. Among the included studies, seven were conducted in the USA ( 9 , 10 , 25 , 27 – 30 ), two studies were conducted in China ( 11 , 23 ), one study was conducted in Spain ( 26 ), and one study was conducted in Italy ( 24 ). Three studies were conducted exclusively in the ICU settings ( 9 , 11 , 24 ).…”

“…Eleven studies reported the overall mortality of COVID-19 patients receiving prophylactic/therapeutic dose anticoagulation therapy or not receiving anticoagulation, which ranged widely across studies from 8.1 to 27.3% for anticoagulation group and 16.4-29.6% for non-anticoagulation group in mild-to-moderate COVID-19 patients, while it ranged from 29.8 to 40% vs. 62.7 to 78.9% in severe to critical COVID-19 patients, respectively (9)(10)(11)(23)(24)(25)(26)(27)(28)(29)(30). Of 14,854 hospitalized COVID-19 patients receiving anticoagulant administration, 2,430 patients died during hospitalization, whereas 1,459 of 5,894 patients who did not receive anticoagulant administration died.…”

Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature

“…24 At a cut-off point of less than 75%, PT activity had a sensitivity of 100% and specificity of 78.08% for predicting mortality. 25 Reyes Gil et al 26 reported that admission PT could significantly differentiate those who were discharged alive and those who died.…”

A disturbed balance between blood complement protective factors (FH, ApoE) and common pathway effectors (C5a, TCC) in acute COVID-19 and during convalesce

“…Acute infection with severe acute coronavirus syndrome coronavirus 2 (SARS CoV-2) manifests via multiple clinical presentations with varying degrees of clinical severity 1 – 3 . The highly heterogeneous natural history of COVID-19 is attributed to interactions between several homeostatic components and viral pathogens 4 – 7 . The loss of complement self-regulation is considered a pivotal factor in COVID-19 outcomes as coagulation abnormalities, increased necrosis, vasculitis, and monocyte overactivation are all hallmarks of COVID-19 8 – 13 .…”