Abstract
BackgroundCoagulation abnormalities in COVID-19 patients accompanied with poor prognosis. This study aimed to determine the prevalence and risk factors of thrombotic events on COVID-19 patients.Methods.We systematically reviewed all the studies about thrombotic events on COVID-19 patients in PubMed, Embase, Web of Science, MedRxiv, bioRxiv, from Dec 1, 2019 to July 5, 2020. The weighted mean difference (MD) or odds ratio (OR) or relative risk (RR) with 95 % confidence intervals (CI) for clinical data in COVID-19 patients with or without thrombotic events was calculated.Results12 articles contained 1083 patients were included for meta-analysis. The prevalence of thrombosis was 22 % (95 % CI 0.08–0.40) in COVID-19 patients and increased to 43 % (95 % CI 0.29–0.65) after admission to the intensive care unit (ICU). Compared with non-thrombotic patients, thrombotic patients had higher levels of D-dimer (MD = 2.79 μg/ml, 95 % CI 2.27–3.31 μg/ml), lactate dehydrogenase (LDH) (MD = 112.71 U/L, 95 % CI 62.40–163.02 U/L), and white blood cells (WBC) (MD = 1.14 *109/L, 95 % CI 0.47–1.81*109/L) while decreased lymphocytes (MD= -0.20*109/L, 95 % CI -0.38 – -0.02*109/L). Age, platelet counts, and male sex tended to be risks while diabetes tended to be a protection for thrombosis for COVID-19 patients, although no statistical difference was achieved. Finally, patients with thrombosis were at a higher risk of death (OR = 2.39, 95 % CI 1.36–4.20).ConclusionsPrevalence of thrombosis in COVID-19 patients was high, especially in ICU, though pharmacologic thromboembolism prophylaxis was applied. Therefore, higher levels of D-dimer, LDH, WBC, and decreased lymphocytes needed to be paid close attention to in patients with COVID-19.
Highlights
Coagulation abnormalities in COVID-19 patients accompanied with poor prognosis
Chen et al [4] found that people who died from COVID19 had longer activated partial thromboplastin time (APTT), higher-level plasma fibrinogen, and D-dimer compared to survivors
Our results show the high prevalence of thrombotic complications in patients with COVID-19, especially in patients with severe conditions admitted to intensive care unit (ICU), even in the cases of widespread use of anticoagulation prevention
Summary
Coagulation abnormalities in COVID-19 patients accompanied with poor prognosis. Up to July 18, there were more than 14 million people infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and causing nearly 600,000 deaths around the world. More and more studies revealed patients infected by SARS-CoV-2 were accompanied by abnormal coagulation parameters which predicted poor prognosis [3]. The prothrombin time (PT) in severe patients was mild prolonged but APTT of dead patients was significantly longer than that of patients who survived [4]. All these coagulation abnormities were observed in SARSCoV-1 and MERS-CoV-1 [7]
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