Manifestations of blood coagulation and its relation to clinical outcomes in severe COVID‐19 patients: Retrospective analysis

Abstract

Introduction: Characteristics of blood coagulation and its relation to clinical outcomes in COVID-19 patients are still rarely reported. We aimed to investigate the blood coagulation function and its influences on clinical outcomes of patients with syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: A total of 71 severe patients with confirmed SARS-CoV-2 infection who were treated in Wuhan First Hospital from February 12 to March 20, 2020, were enrolled. The blood coagulation data in these patients and in 61 healthy controls were collected. The patients with COVID-19 were divided into two groups: the aggravated group and the nonaggravated group, respectively, basing on whether the patients' conditions turned to critically ill or not after admission. Results: Compared with healthy controls, patients with COVID-19 had significant performances with coagulation dysfunction, including dramatically elevated values of FIB, PT, APTT, INR, FDP, and D-Dimers but markedly reduced AT value (P < .05). Importantly, more noteworthy coagulation disorders similar to the differences between patients and controls were found in the aggravated patients with conditions deterioration after admission than those in the nonaggravated patients without conditions deterioration (P < .05). Moreover, the aggravated patients possessed a longer hospital stay and a higher mortality compared with the nonaggravated patients (P < .001). The coagulation parameters of COVID-19 patients were widely and closely related to the indexes of liver function and inflammation (P < .05), indicating the coagulation dysfunction of these patients may be caused by liver injury and inflammatory storm. Conclusion: Severe patients with SARS-CoV-2 infection often possess coagulation dysfunction on admission. A certain correlation exists in coagulation disorder and adverse clinical outcome among severe COVID-19 patients.

A nomogramic model based on clinical and laboratory parameters at admission for predicting the survival of COVID-19 patients

“…Noteworthy, patients with severe SARS-CoV-2 infection often possess coagulation dysfunction at admission [34]. A recent study by Zhang et al demonstrated that INR was a prognostic factor for clinical outcomes in patients with severe COVID-19 [34]. In the present study, we observed that there was also significant in the INR between survival and non-survival group in univariate analysis.…”

“…Therefore, it is not difficult to understand that platelets and D-dimers are independent risk factors that affect the outcome of patients. Noteworthy, patients with severe SARS-CoV-2 infection often possess coagulation dysfunction at admission [34]. A recent study by Zhang et al demonstrated that INR was a prognostic factor for clinical outcomes in patients with severe COVID-19 [34].…”

Coronavirus Disease-19

“… 52 In this study, D-dimer, fibrin degradation products, prothrombin time, and partial thromboplastin time all were significantly increased in nonsurviving patients relative to those surviving COVID-19. 53 Additional studies demonstrate a prothrombotic state in certain patients, with 7 of 12 patients having deep venous thromboses on autopsy. 54 The mechanisms of this COVID-related coagulopathy are not yet well described in the literature; however, these undefined entities pose certain risk for reconstructive efforts in patients with head and neck cancer.…”

Inflammasome Activation-Induced Hypercoagulopathy: Impact on Cardiovascular Dysfunction Triggered in COVID-19 Patients

“…The most common was an alteration in fibrinogen and D-dimer levels, prolonged prothrombin time (PT), and prolonged activated partial thromboplastin time (APTT) [ 50 ]. The amount of D-dimer was higher in patients with severe than mild infection in a related study performed at Wuhan First Hospital, China [ 51 ]. Similarly, mean levels of fibrinogen, D-dimer, and von Willebrand factor (VWF) were shown to be significantly increased in a study conducted in Milan, Italy, on COVID-19 patients in the intensive care unit (ICU).…”