Tiebin Jiang1, Bo Lv2, Hongxia Liu3, Shiwen He4, Guogang Zhang5, Chanyi Li2, Wanqiong Li6, Weilin Li7, Yaqi He4, Tong Zhang4, Yunyun Wang8, Wu Mo7, Ning Yi7, Luying Peng2, Ying Li1, Chunhong Ruan1, Chengyuan Li1, Yaqi Liu1, Peipei Luo1, Huan Jiang1, Zhigang Xue9,10,11, Liang Liu12, Wenjun Wang13,14. 1. Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China. 2. Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, China. 3. Scientometrics and Evaluation Center for Rule of Law, China University of Political Science and Law, Beijing, 100088, China. 4. School of Computer Science and Engineering, Central South University, Changsha, 410083, China. 5. Department of Cardiovascular, The Third Xiangya Hospital, The Central South University, Changsha, 410013, Hunan, China. 6. Reproductive Medicine Center, Tongji Hospital, Tongji University, Shanghai, 200065, China. 7. Stem Cell and Regenerative Medicine Engineering Research Center of Hunan Province, Hunan Yuanpin Cell Technology Co. Ltd, 102 Dongwu Road, Changsha City, 410100, Hunan Province, China. 8. Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan City, 430030, Hubei Province, China. 9. Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, China. xuezg@tongji.edu.cn. 10. Reproductive Medicine Center, Tongji Hospital, Tongji University, Shanghai, 200065, China. xuezg@tongji.edu.cn. 11. Stem Cell and Regenerative Medicine Engineering Research Center of Hunan Province, Hunan Yuanpin Cell Technology Co. Ltd, 102 Dongwu Road, Changsha City, 410100, Hunan Province, China. xuezg@tongji.edu.cn. 12. Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan City, 430030, Hubei Province, China. 907505@qq.com. 13. Stem Cell and Regenerative Medicine Engineering Research Center of Hunan Province, Hunan Yuanpin Cell Technology Co. Ltd, 102 Dongwu Road, Changsha City, 410100, Hunan Province, China. wwj1202@hotmail.com. 14. Department of Spinal Surgery, The First Affiliated Hospital of University of South China, Hengyang, 421002, Hunan, China. wwj1202@hotmail.com.
Abstract
BACKGROUND: The progression of coagulation in COVID-19 patients with confirmed discharge status and the combination of autopsy with complete hemostasis parameters have not been well studied. OBJECTIVE: To clarify the thrombotic phenomena and hemostasis state in COVID-19 patients based on epidemiological statistics combining autopsy and statistical analysis. METHODS: Using autopsy results from 9 patients with COVID-19 pneumonia and the medical records of 407 patients, including 39 deceased patients whose discharge status was certain, time-sequential changes in 11 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Statistical tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severity of COVID-19. RESULTS: At the beginning of hospitalization, platelet (PLT) counts were significantly reduced in critically ill patients compared with severely or mildly ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer levels in critical patients were increased compared with mild and severe patients during the entire admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score was also high in critical patients. In the relatively late stage of nonsurvivors, the temporal changes in PLT count, PT, and D-dimer levels were significantly different from those in survivors. A random forest model indicated that the most important feature was PT followed by D-dimer, indicating their positive associations with disease severity. Autopsy of deceased patients fulfilling diagnostic criteria for DIC revealed microthromboses in multiple organs. CONCLUSIONS: Combining autopsy data, time-sequential changes and statistical methods to explore hemostasis-relevant indices among the different severities of the disease helps guide therapy and detect prognosis in COVID-19 infection.
BACKGROUND: The progression of coagulation in COVID-19patients with confirmed discharge status and the combination of autopsy with complete hemostasis parameters have not been well studied. OBJECTIVE: To clarify the thrombotic phenomena and hemostasis state in COVID-19patients based on epidemiological statistics combining autopsy and statistical analysis. METHODS: Using autopsy results from 9 patients with COVID-19 pneumonia and the medical records of 407 patients, including 39 deceased patients whose discharge status was certain, time-sequential changes in 11 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Statistical tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severity of COVID-19. RESULTS: At the beginning of hospitalization, platelet (PLT) counts were significantly reduced in critically illpatients compared with severely or mildly ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer levels in critical patients were increased compared with mild and severe patients during the entire admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score was also high in critical patients. In the relatively late stage of nonsurvivors, the temporal changes in PLT count, PT, and D-dimer levels were significantly different from those in survivors. A random forest model indicated that the most important feature was PT followed by D-dimer, indicating their positive associations with disease severity. Autopsy of deceased patients fulfilling diagnostic criteria for DIC revealed microthromboses in multiple organs. CONCLUSIONS: Combining autopsy data, time-sequential changes and statistical methods to explore hemostasis-relevant indices among the different severities of the disease helps guide therapy and detect prognosis in COVID-19infection.
Authors: Dominic Wichmann; Jan-Peter Sperhake; Marc Lütgehetmann; Stefan Steurer; Carolin Edler; Axel Heinemann; Fabian Heinrich; Herbert Mushumba; Inga Kniep; Ann Sophie Schröder; Christoph Burdelski; Geraldine de Heer; Axel Nierhaus; Daniel Frings; Susanne Pfefferle; Heinrich Becker; Hanns Bredereke-Wiedling; Andreas de Weerth; Hans-Richard Paschen; Sara Sheikhzadeh-Eggers; Axel Stang; Stefan Schmiedel; Carsten Bokemeyer; Marylyn M Addo; Martin Aepfelbacher; Klaus Püschel; Stefan Kluge Journal: Ann Intern Med Date: 2020-05-06 Impact factor: 25.391
Authors: Zsuzsa Schaff; István Vályi-Nagy; Krisztina Danics; Adrián Pesti; Klára Törő; Noémi Kiss-Dala; János Szlávik; Botond Lakatos; Andrea Radnai; Tamás Balázs; Miklós Bacskai; Deján Dobi; Tibor Várkonyi; Tibor Glasz; Gábor Lotz; András Kiss Journal: Geroscience Date: 2021-09-11 Impact factor: 7.713