Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study

Abstract Background Thrombocytopenia has been implicated in patients infected with severe acute respiratory syndrome coronavirus 2, while the association of platelet count and changes with subsequent mortality remains unclear. Methods The clinical and laboratory data of 383 patients with the definite outcome by March 1, 2020 in the Central Hospital of Wuhan were reviewed. The association between platelet parameters and mortality risk was estimated by utilizing Cox proportional hazard regression models. Results Among the 383 patients, 334 (87.2%) were discharged and survived, and 49 (12.8%) died. Thrombocytopenia at admission was associated with mortality of almost three times as high as that for those without thrombocytopenia (P < 0.05). Cox regression analyses revealed that platelet count was an independent risk factor associated with in-hospital mortality in a dose-dependent manner. An increment of per 50 × 109/L in platelets was associated with a 40% decrease in mortality (hazard ratio: 0.60, 95%CI: 0.43, 0.84). Dynamic changes of platelets were also closely related to death during hospitalization. Conclusions Baseline platelet levels and changes were associated with subsequent mortality. Monitoring platelets during hospitalization may be important in the prognosis of patients with coronavirus disease in 2019.

[1]  Mario Plebani,et al.  Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis , 2020, Clinica Chimica Acta.

[2]  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.

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

[4]  Jiyuan Zhang,et al.  Pathological findings of COVID-19 associated with acute respiratory distress syndrome , 2020, The Lancet Respiratory Medicine.

[5]  K. Pongpirul,et al.  Journey of a Thai Taxi Driver and Novel Coronavirus , 2020, The New England journal of medicine.

[6]  S. Lindstrom,et al.  First Case of 2019 Novel Coronavirus in the United States , 2020, The New England journal of medicine.

[7]  P. Vollmar,et al.  Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany , 2020, The New England journal of medicine.

[8]  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.

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

[10]  E. Passegué,et al.  The lung is a site of platelet biogenesis and a reservoir for hematopoietic progenitors , 2017, Nature.

[11]  C. Ki,et al.  Predictive factors for pneumonia development and progression to respiratory failure in MERS-CoV infected patients , 2016, Journal of Infection.

[12]  G. Ertas,et al.  The independent assocıatıon of plateletcrıt wıth long-term outcomes in patıents undergoıng prımary percutaneous coronary interventıon. , 2014, Journal of critical care.

[13]  D. Christiani,et al.  Thrombocytopenia Is Associated with Acute Respiratory Distress Syndrome Mortality: An International Study , 2014, PloS one.

[14]  Wendy Lim,et al.  The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. , 2011, Chest.

[15]  P. Devos,et al.  Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. , 2007, The Journal of infection.

[16]  Kuender D Yang,et al.  Role of vascular cell adhesion molecules and leukocyte apoptosis in the lymphopenia and thrombocytopenia of patients with severe acute respiratory syndrome (SARS) , 2005, Microbes and Infection.

[17]  Chi-kong Li,et al.  Thrombocytopenia in patients with severe acute respiratory syndrome (review) , 2005, Hematology.

[18]  A. Danchin,et al.  The Severe Acute Respiratory Syndrome , 2003 .

[19]  O. Tsang,et al.  Outcomes and Prognostic Factors in 267 Patients with Severe Acute Respiratory Syndrome in Hong Kong , 2003, Annals of Internal Medicine.

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

[21]  R. Grounds,et al.  Base excess and lactate as prognostic indicators for patients admitted to intensive care , 2001, Intensive Care Medicine.

[22]  R. Bone,et al.  Intravascular coagulation associated with the adult respiratory distress syndrome. , 1976, The American journal of medicine.