tetano
Editor, Senior Moderator
Adv Med Sci
. 2021 Jul 21;66(2):372-380.
doi: 10.1016/j.advms.2021.07.009. Online ahead of print.
INR and COVID-19 severity and mortality: A systematic review with meta-analysis and meta-regression
Angelo Zinellu[SUP] 1 [/SUP], Panagiotis Paliogiannis[SUP] 2 [/SUP], Ciriaco Carru[SUP] 1 [/SUP], Arduino A Mangoni[SUP] 3 [/SUP]
Affiliations
Abstract
Objectives: D-dimer elevations, suggesting a pro-thrombotic state and coagulopathy, predict adverse outcomes in coronavirus disease 2019 (COVID-19). However, the clinical significance of other coagulation markers, particularly the international normalized ratio (INR), is not well established. We conducted a systematic review and meta-analysis of the INR in COVID-19.
Methods: A literature search was conducted in PubMed, Web of Science and Scopus, between January 2020 and February 2021, for studies reporting INR values, measures of COVID-19 severity, and mortality (PROSPERO registration number: CRD42021241468).
Results: Thirty-eight studies in 7440 COVID-19 patients with low disease severity or survivor status during follow up (50 % males, mean age 57 years) and 2331 with high severity or non-survivor status (60 % males, mean age 69 years) were identified. The INR was significantly prolonged in patients with severe disease or non-survivor status than in patients with mild disease or survivor status (standard mean difference, SMD, 0.60; 95 % confidence interval, CI 0.42 to 0.77; p < 0.001). There was extreme between-study heterogeneity (I[SUP]2[/SUP] = 90.2 %; p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified. The Begg's and Egger's t-tests did not show publication bias. In meta-regression, the SMD of the INR was significantly associated with C-reactive protein (p = 0.048) and D-dimer (p = 0.001).
Conclusions: Prolonged INR values were significantly associated with COVID-19 severity and mortality. Both INR prolongation and D-dimer elevations can be useful in diagnosing COVID-19-associated coagulopathy and predicting clinical outcomes.
Keywords: COVID-19 severity; Coagulopathy; International normalized ratio; Mortality.
. 2021 Jul 21;66(2):372-380.
doi: 10.1016/j.advms.2021.07.009. Online ahead of print.
INR and COVID-19 severity and mortality: A systematic review with meta-analysis and meta-regression
Angelo Zinellu[SUP] 1 [/SUP], Panagiotis Paliogiannis[SUP] 2 [/SUP], Ciriaco Carru[SUP] 1 [/SUP], Arduino A Mangoni[SUP] 3 [/SUP]
Affiliations
- PMID: 34315012
- DOI: 10.1016/j.advms.2021.07.009
Abstract
Objectives: D-dimer elevations, suggesting a pro-thrombotic state and coagulopathy, predict adverse outcomes in coronavirus disease 2019 (COVID-19). However, the clinical significance of other coagulation markers, particularly the international normalized ratio (INR), is not well established. We conducted a systematic review and meta-analysis of the INR in COVID-19.
Methods: A literature search was conducted in PubMed, Web of Science and Scopus, between January 2020 and February 2021, for studies reporting INR values, measures of COVID-19 severity, and mortality (PROSPERO registration number: CRD42021241468).
Results: Thirty-eight studies in 7440 COVID-19 patients with low disease severity or survivor status during follow up (50 % males, mean age 57 years) and 2331 with high severity or non-survivor status (60 % males, mean age 69 years) were identified. The INR was significantly prolonged in patients with severe disease or non-survivor status than in patients with mild disease or survivor status (standard mean difference, SMD, 0.60; 95 % confidence interval, CI 0.42 to 0.77; p < 0.001). There was extreme between-study heterogeneity (I[SUP]2[/SUP] = 90.2 %; p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified. The Begg's and Egger's t-tests did not show publication bias. In meta-regression, the SMD of the INR was significantly associated with C-reactive protein (p = 0.048) and D-dimer (p = 0.001).
Conclusions: Prolonged INR values were significantly associated with COVID-19 severity and mortality. Both INR prolongation and D-dimer elevations can be useful in diagnosing COVID-19-associated coagulopathy and predicting clinical outcomes.
Keywords: COVID-19 severity; Coagulopathy; International normalized ratio; Mortality.