Severe COVID-19 and coagulopathy: A systematic review and meta-analysis.
10.47102/annals-acadmedsg.2020420
- Author:
Saikat MITRA
1
;
Ryan Ruiyang LING
;
Isabelle Xiaorui YANG
;
Wynne Hsing POON
;
Chuen Seng TAN
;
Paul MONAGLE
;
Graeme MACLAREN
;
Kollengode RAMANATHAN
Author Information
1. Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore.
- Publication Type:Journal Article
- From:Annals of the Academy of Medicine, Singapore
2021;50(4):325-335
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Coronavirus disease 2019 (COVID-19)-induced coagulopathy (CIC) has been widely reported in the literature. However, the spectrum of abnormalities associated with CIC has been highly variable.
METHODS:We conducted a systematic review of the literature (until 1 June 2020) to assess CIC and disease severity during the early COVID-19 pandemic. Primary outcomes were pooled mean differences in platelet count, D-dimer level, prothrombin time, activated partial thromboplastin time (aPTT) and fibrinogen level between non-severe and severe patients, stratified by degree of hypoxaemia or those who died. The risk factors for CIC were analysed. Random-effects meta-analyses and meta-regression were performed using R version 3.6.1, and certainty of evidence was rated using the Grading of Recommendation, Assessment, Development, and Evaluation approach.
RESULTS:Of the included 5,243 adult COVID-19 patients, patients with severe COVID-19 had a significantly lower platelet count, and higher D-dimer level, prothrombin time and fibrinogen level than non-severe patients. Pooled mean differences in platelet count (-19.7×109/L, 95% confidence interval [CI] -31.7 to -7.6), D-dimer level (0.8μg/mL, 95% CI 0.5-1.1), prothrombin time (0.4 second, 95% CI 0.2-0.6) and fibrinogen level (0.6g/L, 95% CI 0.3-0.8) were significant between the groups. Platelet count and D-dimer level were significant predictors of disease severity on meta-regression analysis. Older men had higher risks of severe coagulopathic disease.
CONCLUSION:Significant variability in CIC exists between non-severe and severe patients, with platelet count and D-dimer level correlating with disease severity. Routine monitoring of all coagulation parameters may help to assess CIC and decide on the appropriate management.
