D-Dimer and Prothrombin Time Are the Significant Indicators of Severe COVID-19 and Poor Prognosis

Abstract

Objective. To investigate the value of coagulation indicators D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fg) in predicting the severity and prognosis of COVID-19. Methods. A total of 115 patients with confirmed COVID-19, who were admitted to Tianyou Hospital of Wuhan University of Science and Technology between January 18, 2020, and March 5, 2020, were included. The dynamic changes of DD, PT, APTT, and Fg were tested, and the correlation with CT imaging, clinical classifications, and prognosis was studied. Results. Coagulation disorder occurred at the early stage of COVID-19 infection, with 50 (43.5%) patients having DD increased and 74 (64.3%) patients having Fg increased. The levels of DD and Fg were correlated with clinical classification. Among 23 patients who deceased, 18 had DD increased at the first lab test, 22 had DD increased at the second and third lab tests, and 18 had prolonged PT at the third test. The results from ROC analyses for mortality risk showed that the AUCs of DD were 0.742, 0.818, and 0.851 in three times of test, respectively; PT was 0.643, 0.824, and 0.937. In addition, with the progression of the disease, the change of CT imaging was closely related to the increase of the DD value (P<0.01). Conclusions. Coagulation dysfunction is more likely to occur in severe and critically ill patients. DD and PT could be used as the significant indicators in predicting the mortality of COVID-19.

Characteristics of coagulation alteration in patients with COVID-19

“…Zhou et al [ 12 ] reported that multivariable regression showed increasing odds of in-hospital death associated with D-dimer > 1 μg/mL on admission. Liu et al [ 22 ] found that increased D-dimer levels at admission were closely related to death through multivariable logistic regression. Wu et al [ 23 ] also reported that D-dimer was associated with progression from ARDS to death in bivariate Cox regression analysis.…”

“…Liu et al [ 11 ] reported that using ROC analyses, the AUC values for PT, FDP, and D-dimer at admission were 0.892, 0.81, and 0.809, respectively, for predicting in-hospital mortality in patients with COVID-19. Another study on COVID-19 also indicated that the AUCs of PT and D-dimer at admission were 0.643 and 0.742 for predicting mortality, and they increased to 0.937 and 0.851, respectively, at the composite endpoint [ 22 ]. Combined with these studies, we argue that the specific parameters of coagulation function, including PT-act at admission, can effectively predict the prognosis of patients with COVID-19.…”

The potential use of ABO blood group system for risk stratification of COVID-19

“…To date, many studies have been launched to evaluate the value of various serum markers in the prediction of COVID-19 severity. Such studies ranged from the use of simple affordable tests such as C-reactive protein (CRP) [3] Ferritin [4] , and D-Dimer [5] to more expensive biomarkers, such as Interleukin 6 and single cell sequencing.…”

Serum iron, prealbumin, D-dimer and prothrombin time are indicators of the diagnosis, severity and outcome of Salmonella enterica serovar Enteritidis infection

“…S. Typhi infection has been reported to activate the coagulation system, increase serum brinogen and D-dimer and prolong PT and APTT [18]. COVID-19 infection may lead to disturbances in the procoagulation, anticoagulation and brinolytic systems [30][31][32][33][34]; a high concentration of D-dimer and prolonged PT are associated with severe COVID-19 and a poor prognosis [24]. In this study, we found that RBCs were detected in the stool of 2 patients, PT was prolonged and D-dimer was elevated in all 6 patients, while APTTs and brinogen levels were normal.…”

“…S. Typhi can activate the coagulation system, and the consumption of coagulation factors could extend the prothrombin time (PT) and the activated partial thromboplastin time (APTT) [18]. D-dimer and PT are signi cant indicators of severe COVID-19 and a poor prognosis [24,25]. However, the correlation between the function of the coagulation system and S. Enteritidis infection remains unclear.…”