Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study

Abstract

Summary Background COVID-19 is an ongoing global pandemic. Changes in haematological characteristics in patients with COVID-19 are emerging as important features of the disease. We aimed to explore the haematological characteristics and related risk factors in patients with COVID-19. Methods This retrospective cohort study included patients with COVID-19 admitted to three designated sites of Wuhan Union Hospital (Wuhan, China). Demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records and compared between patients with moderate, severe, and critical disease (defined according to the diagnosis and treatment protocol for novel coronavirus pneumonia, trial version 7, published by the National Health Commission of China). We assessed the risk factors associated with critical illness and poor prognosis. Dynamic haematological and coagulation parameters were investigated with a linear mixed model, and coagulopathy screening with sepsis-induced coagulopathy and International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation scoring systems was applied. Findings Of 466 patients admitted to hospital from Jan 23 to Feb 23, 2020, 380 patients with COVID-19 were included in our study. The incidence of thrombocytopenia (platelet count <100 × 10 9 cells per L) in patients with critical disease (42 [49%] of 86) was significantly higher than in those with severe (20 [14%] of 145) or moderate (nine [6%] of 149) disease (p<0·0001). The numbers of lymphocytes and eosinophils were significantly lower in patients with critical disease than those with severe or moderate disease (p<0·0001), and prothrombin time, D-dimer, and fibrin degradation products significantly increased with increasing disease severity (p<0·0001). In multivariate analyses, death was associated with increased neutrophil to lymphocyte ratio (≥9·13; odds ratio [OR] 5·39 [95% CI 1·70–17·13], p=0·0042), thrombocytopenia (platelet count <100 × 10 9 per L; OR 8·33 [2·56–27·15], p=0·00045), prolonged prothrombin time (>16 s; OR 4·94 [1·50–16·25], p=0·0094), and increased D-dimer (>2 mg/L; OR 4·41 [1·06–18·30], p=0·041). Thrombotic and haemorrhagic events were common complications in patients who died (19 [35%] of 55). Sepsis-induced coagulopathy and International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation scores (assessed in 12 patients who survived and eight patients who died) increased over time in patients who died. The onset of sepsis-induced coagulopathy was typically before overt disseminated intravascular coagulation. Interpretation Rapid blood tests, including platelet count, prothrombin time, D-dimer, and neutrophil to lymphocyte ratio can help clinicians to assess severity and prognosis of patients with COVID-19. The sepsis-induced coagulopathy scoring system can be used fo...

Characteristics of coagulation alteration in patients with COVID-19

“…Han et al [5] also reported that there was no significant difference in PT between patients with different levels of severity of COVID-19 and healthy controls. However, more studies reported that severe patients had significantly prolonged PT compared with non-severe patients [16][17][18]. In addition, two studies on COVID-19 indicated that non-survivors had higher PT levels than survivors [6,12].…”

Controlling Cytokine Storm Is Vital in COVID-19

“…Most patients had good results with treatment, while the elderly patients and those with chronic diseases usually had poor prognoses. Although most patients with COVID-19 had mild and moderate symptoms, severe and critically ill patients progressed rapidly to acute respiratory failure, ARDS, metabolic acidosis, coagulopathy, septic shock, and MOF (7,(40)(41)(42). The autopsy report in the journal The Lancet Respiratory Medicine showed typical ARDS-like lung injury with lymphocyte infiltration, liver injury with moderate micro-vesicular steatosis, mild lobular and portal activity (43).…”

Immune reactivity during COVID-19: Implications for treatment

“…In fact, standard coagulation parameters, including elevated levels of D-Dimer (DD) (DD ≥ 0.5 mg/L), are often found in patients in patients with poor prognosis [ 14 ]. Despite the exact pathophysiological mechanisms needs to be further investigated, assessing the risk of thrombosis in COVID-19 patients is critical to improve the clinical management in terms of anticoagulation therapy [ [23] , [24] , [25] , [26] ].…”