tetano
Editor, Senior Moderator
J Clin Med
. 2020 Jul 15;9(7):E2244.
doi: 10.3390/jcm9072244.
Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions
Matteo Nicola Dario Di Minno[SUP] 1 [/SUP], Ilenia Calcaterra[SUP] 2 [/SUP], Roberta Lupoli[SUP] 3 [/SUP], Antonio Storino[SUP] 4 [/SUP], Giorgio Alfredo Spedicato[SUP] 5 [/SUP], Mauro Maniscalco[SUP] 4 [/SUP], Alessandro Di Minno[SUP] 6 [/SUP], Pasquale Ambrosino[SUP] 4 [/SUP]
Affiliations
Abstract
Background: Complications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters.
Methods: Data on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated.
Results: Sixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: -0.74; 95%CI: -1.01, -0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: -0.60, 95%CI: -0.82, -0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen.
Conclusions: Significant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients.
Keywords: COVID-19; SARS-CoV-2; coagulation; disability; hemostasis; outcome; thrombosis.
. 2020 Jul 15;9(7):E2244.
doi: 10.3390/jcm9072244.
Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions
Matteo Nicola Dario Di Minno[SUP] 1 [/SUP], Ilenia Calcaterra[SUP] 2 [/SUP], Roberta Lupoli[SUP] 3 [/SUP], Antonio Storino[SUP] 4 [/SUP], Giorgio Alfredo Spedicato[SUP] 5 [/SUP], Mauro Maniscalco[SUP] 4 [/SUP], Alessandro Di Minno[SUP] 6 [/SUP], Pasquale Ambrosino[SUP] 4 [/SUP]
Affiliations
- PMID: 32679766
- DOI: 10.3390/jcm9072244
Abstract
Background: Complications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters.
Methods: Data on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated.
Results: Sixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: -0.74; 95%CI: -1.01, -0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: -0.60, 95%CI: -0.82, -0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen.
Conclusions: Significant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients.
Keywords: COVID-19; SARS-CoV-2; coagulation; disability; hemostasis; outcome; thrombosis.