Runhui Zheng1, Jing Zhou2, Bin Song3, Xia Zheng4, Ming Zhong5, Li Jiang6, Chun Pan7, Wei Zhang8, Jiaan Xia3, Nanshan Chen9, Wenjuan Wu10, Dingyu Zhang11,12, Yin Xi2, Zhimin Lin2, Ying Pan2, Xiaoqing Liu2, Shiyue Li2, Yuanda Xu2, Yimin Li2, Huo Tan13, Nanshan Zhong14, Xiaodan Luo15, Ling Sang16. 1. Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. 2. State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. 3. Department of Tuberculosis and Respiratory Disease, Wuhan Jinyintan Hospital, 430023, Wuhan, China. 4. Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China. 5. Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China. 6. Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China. 7. Department of Critical Care Medicine, Zhongda Hospital, Southeast University, 210009, Nanjing, China. 8. Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, 350025, FuZhou, China. 9. Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China. 10. Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China. 11. Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China. 12. Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, 430023, Wuhan, Hubei, China. 13. Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. tanhuo.2008@163.com. 14. State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. nanshan@vip.163.com. 15. Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. xdluo@gzhmu.edu.cn. 16. State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. sonysang999@aliyun.com.
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.
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.
Authors: Behnood Bikdeli; Mahesh V Madhavan; David Jimenez; Taylor Chuich; Isaac Dreyfus; Elissa Driggin; Caroline Der Nigoghossian; Walter Ageno; Mohammad Madjid; Yutao Guo; Liang V Tang; Yu Hu; Jay Giri; Mary Cushman; Isabelle Quéré; Evangelos P Dimakakos; C Michael Gibson; Giuseppe Lippi; Emmanuel J Favaloro; Jawed Fareed; Joseph A Caprini; Alfonso J Tafur; John R Burton; Dominic P Francese; Elizabeth Y Wang; Anna Falanga; Claire McLintock; Beverley J Hunt; Alex C Spyropoulos; Geoffrey D Barnes; John W Eikelboom; Ido Weinberg; Sam Schulman; Marc Carrier; Gregory Piazza; Joshua A Beckman; P Gabriel Steg; Gregg W Stone; Stephan Rosenkranz; Samuel Z Goldhaber; Sahil A Parikh; Manuel Monreal; Harlan M Krumholz; Stavros V Konstantinides; Jeffrey I Weitz; Gregory Y H Lip Journal: J Am Coll Cardiol Date: 2020-04-17 Impact factor: 24.094
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Authors: H J J M D Song; A Z Q Chia; B K J Tan; C B Teo; V Lim; H R Chua; M Samuel; A Kee Journal: J Endocrinol Invest Date: 2022-09-07 Impact factor: 5.467