Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

Abstract Background As the number of patients increases, there is a growing understanding of the form of pneumonia sustained by the 2019 novel coronavirus (SARS-CoV-2), which has caused an outbreak in China. Up to now, clinical features and treatment of patients infected with SARS-CoV-2 have been reported in detail. However, the relationship between SARS-CoV-2 and coagulation has been scarcely addressed. Our aim is to investigate the blood coagulation function of patients with SARS-CoV-2 infection. Methods In our study, 94 patients with confirmed SARS-CoV-2 infection were admitted in Renmin Hospital of Wuhan University. We prospectively collect blood coagulation data in these patients and in 40 healthy controls during the same period. Results Antithrombin values in patients were lower than that in the control group (p < 0.001). The values of D-dimer, fibrin/fibrinogen degradation products (FDP), and fibrinogen (FIB) in all SARS-CoV-2 cases were substantially higher than those in healthy controls. Moreover, D-dimer and FDP values in patients with severe SARS-CoV-2 infection were higher than those in patients with milder forms. Compared with healthy controls, prothrombin time activity (PT-act) was lower in SARS-CoV-2 patients. Thrombin time in critical SARS-CoV-2 patients was also shorter than that in controls. Conclusions The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.

[1]  Mario Plebani,et al.  Laboratory abnormalities in patients with COVID-2019 infection , 2020, Clinical chemistry and laboratory medicine.

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

[3]  Huixia Yang,et al.  Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records , 2020, The Lancet.

[4]  S. Madoiwa,et al.  Analysis of the association between resolution of disseminated intravascular coagulation (DIC) and treatment outcomes in post-marketing surveillance of thrombomodulin alpha for DIC with infectious disease and with hematological malignancy by organ failure , 2020, Thrombosis Journal.

[5]  T. Lancet Emerging understandings of 2019-nCoV , 2020, The Lancet.

[6]  E. Holmes,et al.  A new coronavirus associated with human respiratory disease in China , 2020, Nature.

[7]  G. Lippi,et al.  Which lessons shall we learn from the 2019 novel coronavirus outbreak? , 2020, Annals of translational medicine.

[8]  Jing Zhao,et al.  Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia , 2020, The New England journal of medicine.

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

[10]  M. Koopmans,et al.  A Novel Coronavirus Emerging in China - Key Questions for Impact Assessment. , 2020, The New England journal of medicine.

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

[12]  Victor M Corman,et al.  Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR , 2020, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[13]  H. Minasyan,et al.  Blood coagulation: a powerful bactericidal mechanism of human innate immunity , 2019, International reviews of immunology.

[14]  Zhènglì Shí,et al.  Origin and evolution of pathogenic coronaviruses , 2018, Nature Reviews Microbiology.

[15]  Christian Drosten,et al.  Commentary: Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Announcement of the Coronavirus Study Group , 2013, Journal of Virology.

[16]  A. Osterhaus,et al.  Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. , 2012, The New England journal of medicine.

[17]  A. Norrby-Teglund,et al.  Coagulation, an ancestral serine protease cascade, exerts a novel function in early immune defense. , 2011, Blood.

[18]  P. Lollar,et al.  Involvement of the contact phase and intrinsic pathway in herpes simplex virus‐initiated plasma coagulation , 2010, Journal of thrombosis and haemostasis : JTH.

[19]  E. Conway,et al.  Coagulation and innate immune responses: can we view them separately? , 2009, Blood.

[20]  M. Rapala-Kozik,et al.  Kininogen adsorption to the cell surface of Candida spp. , 2008, International immunopharmacology.

[21]  J. Peiris,et al.  Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003 , 2003, The Lancet.

[22]  J. Peiris,et al.  Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome , 2003, The Lancet.

[23]  Christian Drosten,et al.  Identification of a novel coronavirus in patients with severe acute respiratory syndrome. , 2003, The New England journal of medicine.

[24]  J. A. Comer,et al.  A novel coronavirus associated with severe acute respiratory syndrome. , 2003, The New England journal of medicine.

[25]  T. van der Poll,et al.  Disseminated Intravascular Coagulation , 1999, Thrombosis and Haemostasis.