Prevalence and Impact of Coagulation Dysfunction in COVID-19 in China: A Meta-Analysis

Background  The aim of this meta-analysis is to assess the prevalence of coagulation dysfunction in Chinese COVID-19 patients and to determine the association of coagulopathy with the severity and prognosis of COVID-19. Methods  A meta-analysis of the prevalence of different abnormal coagulation indicators in COVID-19 patients in China was performed. The difference of coagulation indicators and the incidence of DIC were compared between severe cases and nonsevere cases as well as nonsurvivors and survivors, respectively. Results  A total of 22 Chinese studies involving 4,889 confirmed COVID-19 inpatients were included. The average D-dimer value of COVID-19 patients is 0.67 µg/mL (95% confidence interval [CI]: 0.56–0.78), and 29.3% (95% CI: 20.1–38.5%) of patients showed elevated D-dimer values. Severe patients had significantly higher D-dimer levels and prolonged prothrombin time (PT) compared with nonsevere patients. Nonsurvivors had significantly higher D-dimer levels, prolonged PT, and decreased platelet count compared with survivors. In total, 6.2% (95% CI: 2.6–9.9%) COVID-19 patients were complicated by disseminated intravascular coagulation (DIC), in which the log risk ratio in nonsurvivors was 3.267 (95% CI: 2.191–4.342, Z  = 5.95, p  < 0.05) compared with that in survivors. Conclusion  The prevalence of coagulopathy in Chinese COVID-19 inpatients is high, and both the abnormal coagulation indicators and DIC are closely associated with the severity and poor prognosis of these COVID-19 patients. Therefore, attention should be paid to coagulation dysfunction in COVID-19 patients. Closely monitoring of coagulation indicators and application of appropriate anticoagulation may improve the prognosis of COVID-19 inpatients in China.

[1]  N. O'Connell,et al.  More on COVID‐19 coagulopathy in Caucasian patients , 2020, British journal of haematology.

[2]  Yaolong Chen,et al.  Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines , 2020, Thrombosis and Haemostasis.

[3]  K. Syrigos,et al.  Thromboembolic risk and anticoagulant therapy in COVID‐19 patients: emerging evidence and call for action , 2020, British journal of haematology.

[4]  D. Gommers,et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19 , 2020, Thrombosis Research.

[5]  Feng Wang,et al.  Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia , 2020, Journal of Thrombosis and Haemostasis.

[6]  Xiaowei Yan,et al.  Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19 , 2020, The New England journal of medicine.

[7]  C. Eastin,et al.  Clinical Characteristics of Coronavirus Disease 2019 in China , 2020, The Journal of Emergency Medicine.

[8]  G. Ippolito,et al.  COVID-19, SARS and MERS: are they closely related? , 2020, Clinical Microbiology and Infection.

[9]  Dengju Li,et al.  Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy , 2020, Journal of Thrombosis and Haemostasis.

[10]  Ke Ma,et al.  Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study , 2020, BMJ.

[11]  A. Falanga,et al.  ISTH interim guidance on recognition and management of coagulopathy in COVID‐19 , 2020, Journal of Thrombosis and Haemostasis.

[12]  W. Gong,et al.  Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. , 2020, JAMA cardiology.

[13]  Y. Xiong,et al.  Clinical features and treatment of COVID‐19 patients in northeast Chongqing , 2020, Journal of medical virology.

[14]  Wei Liu,et al.  Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study , 2020, Chinese medical journal.

[15]  M. Frieman,et al.  COVID-19: Knowns, Unknowns, and Questions , 2020, mSphere.

[16]  Jie Zhang,et al.  Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis , 2020, Respiratory Research.

[17]  R. Liu,et al.  Prominent changes in blood coagulation of patients with SARS-CoV-2 infection , 2020, Clinical chemistry and laboratory medicine.

[18]  Hong Jiang,et al.  Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up , 2020, Journal of Infection.

[19]  W. Tu,et al.  Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  Xin Zhou,et al.  Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China , 2020, The Journal of Emergency Medicine.

[21]  J. Xiang,et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study , 2020, The Lancet.

[22]  C. Cheung,et al.  Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19) , 2020, Journal of General Internal Medicine.

[23]  Wei Liu,et al.  Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease , 2020, Chinese medical journal.

[24]  K. Yuen,et al.  Clinical Characteristics of Coronavirus Disease 2019 in China , 2020, The New England journal of medicine.

[25]  Wenjie Yang,et al.  Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China , 2020, Journal of Infection.

[26]  X. Yue,et al.  Review and Prospect of Pathological Features of Corona Virus Disease. , 2020, Fa yi xue za zhi.

[27]  C. Shi,et al.  Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series , 2020, medRxiv.

[28]  Ting Yu,et al.  Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study , 2020, The Lancet Respiratory Medicine.

[29]  C. Akdis,et al.  Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China , 2020, Allergy.

[30]  Dengju Li,et al.  Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia , 2020, Journal of Thrombosis and Haemostasis.

[31]  Lei Liu,et al.  COVID‐19 in a designated infectious diseases hospital outside Hubei Province, China , 2020, medRxiv.

[32]  Yan Zhao,et al.  Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. , 2020, JAMA.

[33]  Kai Zhao,et al.  A pneumonia outbreak associated with a new coronavirus of probable bat origin , 2020, Nature.

[34]  Ting Yu,et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study , 2020, The Lancet.

[35]  G. Gao,et al.  A Novel Coronavirus from Patients with Pneumonia in China, 2019 , 2020, The New England journal of medicine.

[36]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[37]  M. Weigand,et al.  Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study , 2019, Annals of Intensive Care.

[38]  M. Di Nisio,et al.  A Proposal of the Modification of Japanese Society on Thrombosis and Hemostasis (JSTH) Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Sepsis-Associated DIC , 2018, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[39]  Pingsheng Wu,et al.  The effect of statins on microalbuminuria, proteinuria, progression of kidney function, and all-cause mortality in patients with non-end stage chronic kidney disease: A meta-analysis. , 2016, Pharmacological research.

[40]  Jiming Liu,et al.  Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range , 2014, BMC Medical Research Methodology.

[41]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[42]  J. Sung,et al.  Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis , 2003, BMJ : British Medical Journal.

[43]  Peter Cameron,et al.  A major outbreak of severe acute respiratory syndrome in Hong Kong. , 2003, The New England journal of medicine.