Early coagulation tests predict risk stratification and prognosis of COVID-19

Abstract

The ongoing outbreak of Coronavirus Disease 2019 (COVID-19) is hitting the world hard, but the relationship between coagulation disorders and COVID-19 is still not clear. This study aimed to explore whether early coagulation tests can predict risk stratification and prognosis. PubMed, Web of Science, Cochrane Library, and Scopus were searched electronically for relevant research studies published up to March 24, 2020, producing 24 articles for the final inclusion. The pooled standard mean difference (SMD) of coagulation parameters at admission were calculated to determine severe and composite endpoint conditions (ICU or death) in COVID-19 patients. Meta-analyses revealed that platelet count was not statistically related to disease severity and composite endpoint; elevated D-dimer correlated positively with disease severity (SMD 0.787 (0.277-1.298), P= 0.003, I 2 = 96.7%) but had no significant statistical relationship with composite endpoints. Similarly, patients with prolonged prothrombin time (PT) had an increased risk of ICU and increased risk of death (SMD 1.338 (0.551-2.125), P = 0.001, I 2 = 92.7%). Besides, increased fibrin degradation products (FDP) and decreased antithrombin might also mean the disease is worsening. Therefore, early coagulation tests followed by dynamic monitoring is useful for recognizing coagulation disorders accompanied by COVID-19 and guiding timely therapy to improve prognosis.

Identification of parameters in routine blood and coagulation tests related to the severity of COVID-19

“…Additionally, our study indicated that FDP was a risk factor associated with the development of critical COVID-19; more importantly, we identified that the AUROC of the FDP level was 0.71 with a cutoff of 0.95 µg/ml. These findings strengthen the suggestion that routine monitoring of coagulation parameters may represent a potentially useful tool to improve the early diagnosis of critical COVID-19 and establish an accurate therapeutic strategy 38 , 39 . It has been widely demonstrated that coagulation is activated and accelerated in response to infections because this mechanism may increase the physiological response 40 , 41 .…”

An Artificial Intelligence Model to Predict the Mortality of COVID-19 Patients at Hospital Admission Time Using Routine Blood Samples: Development and Validation of an Ensemble Model

“…Urea and estimated glomerular filtration rate are important lab findings associated with an underlying chronic renal disease, which is a well-known predisposing factor of mortality [ 34 ]. In terms of the coagulation profile, COVID-19 generally presents a hypercoagulation state, thus resulting in an elevated prothrombin time and international normalized ratio in severe COVID-19 cases [ 3 , 18 ].…”

“…Particularly, the condition of patients at high risk can rapidly deteriorate. Some papers reported that deceased COVID-19 patients initially had mild symptoms but suddenly transitioned to a critical stage, leading to death [ 3 - 5 ]. In Italy, 75% of deceased patients showed mild symptoms, such as fever, dyspnea, and cough, at admission to the hospital [ 1 ].…”

Review of the Prognosis Factors of COVID-19 Infection

“…1) D-dimers D-dimer elevation is a very common laboratory finding observed in COVID-19 patients, requiring hospitalization and predicting a poor prognosis [19] [42] [45] [46]. In fact, SARS-CoV-2 enters cells via ACE2 receptors, which are found in endothelial cells.…”