tetano
Editor, Senior Moderator
Sci Rep
. 2021 May 17;11(1):10464.
doi: 10.1038/s41598-021-89967-x.
Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients
Alberto Polimeni[SUP] 1 2 [/SUP], Isabella Leo[SUP] 1 [/SUP], Carmen Spaccarotella[SUP] 1 2 [/SUP], Annalisa Mongiardo[SUP] 1 [/SUP], Sabato Sorrentino[SUP] 1 2 [/SUP], Jolanda Sabatino[SUP] 1 2 [/SUP], Salvatore De Rosa[SUP] 1 2 [/SUP], Ciro Indolfi[SUP] 3 4 5 [/SUP]
Affiliations
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD - 2.15 [- 2.73 to - 1.56], I[SUP]2[/SUP] 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD - 2.91 [- 3.87 to - 1.96], I[SUP]2[/SUP] 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I[SUP]2[/SUP] 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I[SUP]2[/SUP] 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD - 1.34 [- 2.06 to - 0.62], I[SUP]2[/SUP] 98%, P < 0.0002) and Survivors groups (SMD - 1.61 [- 2.69 to - 0.54], I[SUP]2[/SUP] 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.
. 2021 May 17;11(1):10464.
doi: 10.1038/s41598-021-89967-x.
Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients
Alberto Polimeni[SUP] 1 2 [/SUP], Isabella Leo[SUP] 1 [/SUP], Carmen Spaccarotella[SUP] 1 2 [/SUP], Annalisa Mongiardo[SUP] 1 [/SUP], Sabato Sorrentino[SUP] 1 2 [/SUP], Jolanda Sabatino[SUP] 1 2 [/SUP], Salvatore De Rosa[SUP] 1 2 [/SUP], Ciro Indolfi[SUP] 3 4 5 [/SUP]
Affiliations
- PMID: 34001992
- DOI: 10.1038/s41598-021-89967-x
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD - 2.15 [- 2.73 to - 1.56], I[SUP]2[/SUP] 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD - 2.91 [- 3.87 to - 1.96], I[SUP]2[/SUP] 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I[SUP]2[/SUP] 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I[SUP]2[/SUP] 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD - 1.34 [- 2.06 to - 0.62], I[SUP]2[/SUP] 98%, P < 0.0002) and Survivors groups (SMD - 1.61 [- 2.69 to - 0.54], I[SUP]2[/SUP] 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.