Abstract
The new outbreak of Coronavirus Disease 2019 (COVID-19) has emerged as a serious global public health concern. A more in-depth study of blood coagulation abnormality is needed. We retrospectively analyzed 147 consecutive patients with COVID-19 who were admitted to three ICUs in Wuhan from February 9th, 2020 to March 20th, 2020. The baseline coagulation and other characteristics were studied. Our results showed that the prolonged PT, FDP, DD were positively correlated with the levels of neutrophils, ferritin, LDH, total bilirubin, multi-inflammation cytokines, and negatively correlated with the lymphocytes level (p < 0.01). The level of ATIII was significantly negatively correlated with the levels of neutrophils, ferritin, LDH, total bilirubin, IL2R, IL6 and IL8 (p < 0.05). The patients in the ARDS group had a more prominent abnormality in PT, FDP, DD and ATIII, while the patients in the AKI group had more prolonged PT, more severe FDP and DD level, more inferior ATIII and Fib level than those in the non-AKI group (p < 0.01). The value of PT, DD and FDP were positively correlated with the classical APACHE II, SOFA and qSOFA scores, while the ATIII was negatively correlated with them (p < 0.001). The high levels of PT, FDP and DD were correlated with in-hospital mortality (p < 0.001). In conclusion, blood coagulation disorder was prominent in ICU patients with COVID-19 and was correlated with multi-inflammation factors. The abnormality of blood coagulation parameters could be an adverse prognostic indicator for ICU patients with COVID-19.
Highlights
The infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was firstly reported by China [1], is seriously endangering the public healthcare systems worldwide
The values of prothrombin time (PT), DD and fibrinogen degradation products (FDP) were positively correlated with the classical APACHE II, Sepsis-related Organ Failure Assessment (SOFA), qSOFA scores, while antithrombin III (ATIII) was negatively correlated with them, which have shown to be important predictors for the in-hospital mortality in our cohort (p < 0.001)
We did not find an impact of ATT and Fib on the mortality. In this retrospective cohort study, we found that the infection of SARS-CoV-2 can lead to prominent coagulation abnormalities
Summary
The infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was firstly reported by China [1], is seriously endangering the public healthcare systems worldwide. A pandemic of the Coronavirus Disease 2019 (COVID-19) has been declared by the World Health Organization. The number of infected patients in the world is rapidly increasing and has exceeded 3 million, while the number of related deaths has reached more than 217,769 as of 1st May 2020 [2]. Several reports elucidated the abnormalities of blood coagulation in patients with COVID-19 [5,6,7]. An in-depth study of blood coagulation abnormality, influencing factors, the relationship between blood coagulation and inflammation reaction, and the impact on prognosis is still needed. This study set out with the aim of assessing the importance of the blood coagulation system abnormalities in patients with COVID19 and discussing the characteristics, influencing factors, and its prognosis
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