Morayma Reyes Gil1, Jesus D Gonzalez-Lugo2, Shafia Rahman2, Mohammad Barouqa1, James Szymanski1, Kenji Ikemura1, Yungtai Lo3, Henny H Billett4. 1. Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States. 2. Division of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States. 4. Division of Hematology, Departments of Oncology and Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States.
Abstract
IMPORTANCE: COVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020. OBJECTIVE: To investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death. DESIGN: Retrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020. SETTING: Montefiore Health System main hospital, Moses, a large tertiary care center in the Bronx. PARTICIPANTS: Adult inpatients with positive COVID tests hospitalized at MHS. EXPOSURE FOR OBSERVATIONAL STUDIES: Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data. MAIN OUTCOME AND MEASURES: Relationship and predictive value of measured parameters to mortality and illness severity. RESULTS: Of the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged). CONCLUSION: We describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.
IMPORTANCE: COVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020. OBJECTIVE: To investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death. DESIGN: Retrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020. SETTING: Montefiore Health System main hospital, Moses, a large tertiary care center in the Bronx. PARTICIPANTS: Adult inpatients with positive COVID tests hospitalized at MHS. EXPOSURE FOR OBSERVATIONAL STUDIES: Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data. MAIN OUTCOME AND MEASURES: Relationship and predictive value of measured parameters to mortality and illness severity. RESULTS: Of the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged). CONCLUSION: We describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.
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Authors: Baris Gungor; Adem Atici; Omer Faruk Baycan; Gokhan Alici; Fatih Ozturk; Sevil Tugrul; Ramazan Asoglu; Erdem Cevik; Irfan Sahin; Hasan Ali Barman Journal: Am J Emerg Med Date: 2020-09-14 Impact factor: 4.093
Authors: Parag Goyal; Justin J Choi; Laura C Pinheiro; Edward J Schenck; Ruijun Chen; Assem Jabri; Michael J Satlin; Thomas R Campion; Musarrat Nahid; Joanna B Ringel; Katherine L Hoffman; Mark N Alshak; Han A Li; Graham T Wehmeyer; Mangala Rajan; Evgeniya Reshetnyak; Nathaniel Hupert; Evelyn M Horn; Fernando J Martinez; Roy M Gulick; Monika M Safford Journal: N Engl J Med Date: 2020-04-17 Impact factor: 176.079