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Systematic Review
Prognostic Impact of Coagulopathy in Patients with COVID-19: a Meta-analysis of 35 Studies and 6427 Patients
Ciro Indolfi
Division of Cardiology and Center for Cardiovascular Research, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
Corresponding Author
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Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH-criteria for disseminated intravascular coagulopathy (DIC). We conducted a meta-analysis of all available studies on COVID-19 to explore the impact of coagulopathy on severe illness and mortality. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. The primary analysis showed that mean d-dimer is significantly higher in COVID-19 patients with severe disease than in those without (SMD -2.15 [-2.73 to -1.56], I2 98%, P <0.0001). Additional analysis of platelet count showed lower levels of mean PLT in Severe patients than those observed in the Non-Severe patients (SMD 0.77 [0.32 to 1.22], I2 96%, P <0.001). Interestingly, longer mean PT was found in Severe group (SMD -1.34 [-2.06 to -0.62], I2 98%, P <0.0002) compared to Non-Severe group. In conclusion, the results of the present meta-analysis, the largest and most comprehensive to date, demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT.
Keywords
COVID-19, coagulopathy, meta-analysis, D-dimer values, platelet count
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This preprint is under consideration at a Nature Portfolio Journal. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Nature journals have partnered with Research Square to offer In Review, a journal-integrated preprint deposition service.
Systematic Review
Prognostic Impact of Coagulopathy in Patients with COVID-19: a Meta-analysis of 35 Studies and 6427 Patients
Ciro Indolfi
Division of Cardiology and Center for Cardiovascular Research, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH-criteria for disseminated intravascular coagulopathy (DIC). We conducted a meta-analysis of all available studies on COVID-19 to explore the impact of coagulopathy on severe illness and mortality. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. The primary analysis showed that mean d-dimer is significantly higher in COVID-19 patients with severe disease than in those without (SMD -2.15 [-2.73 to -1.56], I2 98%, P <0.0001). Additional analysis of platelet count showed lower levels of mean PLT in Severe patients than those observed in the Non-Severe patients (SMD 0.77 [0.32 to 1.22], I2 96%, P <0.001). Interestingly, longer mean PT was found in Severe group (SMD -1.34 [-2.06 to -0.62], I2 98%, P <0.0002) compared to Non-Severe group. In conclusion, the results of the present meta-analysis, the largest and most comprehensive to date, demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT.
Figure 1
Figure 2
Figure 3
Figure 4