COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU
Abstract Background Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases. Methods We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020. Results Of 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of < 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of < 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was < 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality. Conclusions A D-dimer concentration of < 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of < 4 and DIC score of < 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of < 2 mg/L or DIC score of ≥ 5..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:10 |
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| Enthalten in: |
Experimental Hematology & Oncology - 10(2021), 1, Seite 11 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Runhui Zheng [VerfasserIn] |
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| Links: |
doi.org [kostenfrei] |
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| doi: |
10.1186/s40164-021-00202-9 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
DOAJ053626974 |
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| 520 | |a Abstract Background Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases. Methods We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020. Results Of 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of < 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of < 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was < 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality. Conclusions A D-dimer concentration of < 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of < 4 and DIC score of < 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of < 2 mg/L or DIC score of ≥ 5. | ||
| 650 | 4 | |a Coagulation parameters | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a D-dimer | |
| 650 | 4 | |a Sepsis‐induced coagulopathy | |
| 650 | 4 | |a Disseminated intravascular coagulation | |
| 653 | 0 | |a Diseases of the blood and blood-forming organs | |
| 653 | 0 | |a Neoplasms. Tumors. Oncology. Including cancer and carcinogens | |
| 700 | 0 | |a Jing Zhou |e verfasserin |4 aut | |
| 700 | 0 | |a Bin Song |e verfasserin |4 aut | |
| 700 | 0 | |a Xia Zheng |e verfasserin |4 aut | |
| 700 | 0 | |a Ming Zhong |e verfasserin |4 aut | |
| 700 | 0 | |a Li Jiang |e verfasserin |4 aut | |
| 700 | 0 | |a Chun Pan |e verfasserin |4 aut | |
| 700 | 0 | |a Wei Zhang |e verfasserin |4 aut | |
| 700 | 0 | |a Jiaan Xia |e verfasserin |4 aut | |
| 700 | 0 | |a Nanshan Chen |e verfasserin |4 aut | |
| 700 | 0 | |a Wenjuan Wu |e verfasserin |4 aut | |
| 700 | 0 | |a Dingyu Zhang |e verfasserin |4 aut | |
| 700 | 0 | |a Yin Xi |e verfasserin |4 aut | |
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| 700 | 0 | |a Ying Pan |e verfasserin |4 aut | |
| 700 | 0 | |a Xiaoqing Liu |e verfasserin |4 aut | |
| 700 | 0 | |a Shiyue Li |e verfasserin |4 aut | |
| 700 | 0 | |a Yuanda Xu |e verfasserin |4 aut | |
| 700 | 0 | |a Yimin Li |e verfasserin |4 aut | |
| 700 | 0 | |a Huo Tan |e verfasserin |4 aut | |
| 700 | 0 | |a Nanshan Zhong |e verfasserin |4 aut | |
| 700 | 0 | |a Xiaodan Luo |e verfasserin |4 aut | |
| 700 | 0 | |a Ling Sang |e verfasserin |4 aut | |
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