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...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | Experimental Hematology & Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40164-021-00202-9 |
| _version_ | 1818452762672758784 |
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| author | Runhui Zheng Jing Zhou Bin Song Xia Zheng Ming Zhong Li Jiang Chun Pan Wei Zhang Jiaan Xia Nanshan Chen Wenjuan Wu Dingyu Zhang Yin Xi Zhimin Lin Ying Pan Xiaoqing Liu Shiyue Li Yuanda Xu Yimin Li Huo Tan Nanshan Zhong Xiaodan Luo Ling Sang |
| author_facet | Runhui Zheng Jing Zhou Bin Song Xia Zheng Ming Zhong Li Jiang Chun Pan Wei Zhang Jiaan Xia Nanshan Chen Wenjuan Wu Dingyu Zhang Yin Xi Zhimin Lin Ying Pan Xiaoqing Liu Shiyue Li Yuanda Xu Yimin Li Huo Tan Nanshan Zhong Xiaodan Luo Ling Sang |
| author_sort | Runhui Zheng |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T21:28:15Z |
| format | Article |
| id | doaj.art-55891629133d4136af3e496783d4a742 |
| institution | Directory Open Access Journal |
| issn | 2162-3619 |
| language | English |
| last_indexed | 2024-12-14T21:28:15Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Experimental Hematology & Oncology |
| spelling | doaj.art-55891629133d4136af3e496783d4a7422022-12-21T22:46:45ZengBMCExperimental Hematology & Oncology2162-36192021-02-0110111110.1186/s40164-021-00202-9COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICURunhui Zheng0Jing Zhou1Bin Song2Xia Zheng3Ming Zhong4Li Jiang5Chun Pan6Wei Zhang7Jiaan Xia8Nanshan Chen9Wenjuan Wu10Dingyu Zhang11Yin Xi12Zhimin Lin13Ying Pan14Xiaoqing Liu15Shiyue Li16Yuanda Xu17Yimin Li18Huo Tan19Nanshan Zhong20Xiaodan Luo21Ling Sang22Hematology Department, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityDepartment of Tuberculosis and Respiratory Disease, Wuhan Jinyintan HospitalDepartment of Critical Care Medicine, The First Affiliated Hospital of Zhejiang UniversityDepartment of Critical Care Medicine, Zhongshan Hospital Fudan UniversityDepartment of Critical Care Medicine, Xuanwu Hospital, Capital Medical UniversityDepartment of Critical Care Medicine, Zhongda Hospital, Southeast UniversityEmergency Department, The 900th Hospital of Joint Service Corps of Chinese PLADepartment of Tuberculosis and Respiratory Disease, Wuhan Jinyintan HospitalDepartment of Respiratory and Critical Care Medicine, Wuhan Jinyintan HospitalDepartment of Critical Care Medicine, Wuhan Jinyintan HospitalResearch Center for Translational Medicine, Wuhan Jinyintan HospitalState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityHematology Department, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityHematology Department, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical UniversityAbstract 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.https://doi.org/10.1186/s40164-021-00202-9Coagulation parametersCOVID-19D-dimerSepsis‐induced coagulopathyDisseminated intravascular coagulation |
| spellingShingle | Runhui Zheng Jing Zhou Bin Song Xia Zheng Ming Zhong Li Jiang Chun Pan Wei Zhang Jiaan Xia Nanshan Chen Wenjuan Wu Dingyu Zhang Yin Xi Zhimin Lin Ying Pan Xiaoqing Liu Shiyue Li Yuanda Xu Yimin Li Huo Tan Nanshan Zhong Xiaodan Luo Ling Sang COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU Experimental Hematology & Oncology Coagulation parameters COVID-19 D-dimer Sepsis‐induced coagulopathy Disseminated intravascular coagulation |
| title | COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU |
| title_full | COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU |
| title_fullStr | COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU |
| title_full_unstemmed | COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU |
| title_short | COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU |
| title_sort | covid 19 associated coagulopathy thromboembolism prophylaxis and poor prognosis in icu |
| topic | Coagulation parameters COVID-19 D-dimer Sepsis‐induced coagulopathy Disseminated intravascular coagulation |
| url | https://doi.org/10.1186/s40164-021-00202-9 |
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