COVID-19 pneumonia: abnormal coagulation factors are prognostic for poor outcomes

  • Tang N & al.
  • J Thromb Haemost
  • 19 Feb 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Abnormal conventional coagulation parameters, e.g., elevated D-dimer and fibrin degradation product (FDP) levels, are associated with poorer outcomes in novel coronavirus pneumonia (NCP).
  • Disseminated intravascular coagulation (DIC) ≥5 points in later-stage illness is associated with mortality. 

Why this matters

  • Coagulation testing may serve to guide NCP management. 

Key results

  • 183 patients with NCP.
  • Mean age, disease onset: 54.1 (range, 14-94) years.
  • 41.0% (75) had chronic diseases.
  • All patients received antiviral, supportive therapies.
  • 11.5% (21) died.
  • 71.4% (15) nonsurvivors vs 0.6% (1) survivors matched International Society on Thrombosis and Haemostasis diagnostic criteria for overt-DIC.
  • Median time, admission-DIC: 4 (range, 1-12) days.
  • At admission, nonsurvivors had significantly higher:
    • D-dimer (µg/mL): 2.12 (0.77-5.27) vs 0.61 (0.35-1.29) survivors.
    • FDP (µg/mL): 7.6 (4.0-23.4) vs 4.0 (4.0-4.9) survivors.
    • Prothrombin time (PT, seconds): 15.5 (14.4-16.3) vs 13.6 (13.0-14.3) survivors, respectively; P<.001 all.>
  • Late hospitalization, fibrinogen, antithrombin levels significantly lower in nonsurvivors, suggesting link between conventional coagulation parameters and prognosis during disease course.

Study design

  • Retrospective analysis of coagulation parameters in consecutive NCP cases, outcomes, in patients from Wuhan, China hospitalized with confirmed infections, January 1-February 3, 2020.
  • Funding: None disclosed.

Limitations

  • Single center, small patient numbers.
  • Limited generalizability.