Prominent coagulation disorder is closely related to inflammatory response and could be as a prognostic indicator for ICU patients with COVID-19

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.

Characteristics of coagulation alteration in patients with COVID-19

“…Compared with moderate patients, severe patients more frequently had dyspnea and lymphopenia, with markedly higher levels of IL-2R, IL-6, IL-10, and TNF-α [8]. The severe inflammatory state secondary to COVID-19 leads to severe derangement of hemostasis and prominent alternation of coagulation parameters [4,[9][10][11]. It is generally believed that deterioration of coagulation parameters during the disease course is closely associated with COVID-19 worsening and death.…”

“…Combined with the fact that PT-act < 75% is an independent risk factor for patient death, we argue that PT-act is a useful index for predicting COVID-19 patient death. 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 inhospital mortality in patients with COVID-19. Another study on COVID-19 also indicated that the AUCs of PT and Ddimer 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].…”

The Neurological Complexities and Prognosis of COVID-19

“…The prognostic value and biomarkers of the SARS-CoV-2 and its effects on the CNS and PNS vary among subjects depending on age, comorbidities, immunocompetency, and disease severity. As SARS-CoV-2 exerts its mechanism via overactivation of the inflammatory response, increased hypercoagulability, and decreased anticoagulable processes, inflammatory markers, and coagulation tests may be predictive of prognosis [47]. A study conducted by Liu et al [47] reported conventional hematologic analysis examining coagulation parameters; Prothrombin time, fibrin degradation products (FDP), and D-dimer (DD) served as prognostic biomarkers for individuals with increased mortality in COVID-19 confirmed ICU subjects.…”

“…As SARS-CoV-2 exerts its mechanism via overactivation of the inflammatory response, increased hypercoagulability, and decreased anticoagulable processes, inflammatory markers, and coagulation tests may be predictive of prognosis [47]. A study conducted by Liu et al [47] reported conventional hematologic analysis examining coagulation parameters; Prothrombin time, fibrin degradation products (FDP), and D-dimer (DD) served as prognostic biomarkers for individuals with increased mortality in COVID-19 confirmed ICU subjects. The study also reported antithrombin III (ATIII) as a biomarker for increased survival in ICU patients, concluding PT, DD, FDP, and ATIII to be predictors of prognosis [47].…”

“…A study conducted by Liu et al [47] reported conventional hematologic analysis examining coagulation parameters; Prothrombin time, fibrin degradation products (FDP), and D-dimer (DD) served as prognostic biomarkers for individuals with increased mortality in COVID-19 confirmed ICU subjects. The study also reported antithrombin III (ATIII) as a biomarker for increased survival in ICU patients, concluding PT, DD, FDP, and ATIII to be predictors of prognosis [47].…”