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COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU
Runhui Zheng1, Jing Zhou2, Bin Song3
1Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.
Insights
COVID-19 patients with high D-dimer levels (>0.5 mg/L) face increased mortality risk. Thromboembolic prophylaxis, particularly enoxaparin, may reduce deaths in severe cases with elevated D-dimer or DIC scores.
Area of Science:
- Medical research
- Hematology
- Critical care medicine
Background:
- Coronavirus disease 2019 (COVID-19) is linked to coagulation abnormalities.
- These abnormalities are indicators of higher mortality, especially in severe COVID-19 cases.
Purpose of the Study:
- To investigate the association between coagulation parameters and mortality in COVID-19 patients.
- To evaluate the effectiveness of thromboembolic prophylaxis in reducing mortality.
Main Methods:
- Retrospective study of 180 COVID-19 patients in an intensive care unit.
- Analysis of D-dimer levels, Sepsis-Induced Coagulopathy (SIC) score, and Disseminated Intravascular Coagulation (DIC) score.
- Assessment of enoxaparin administration for thromboembolic prophylaxis.
Main Results:
- A D-dimer concentration >0.5 mg/L on admission was significantly associated with 30-day mortality.
- Higher D-dimer levels (>5 mg/L), elevated SIC scores (≥4), and DIC scores (≥5) were observed in non-survivors.
- Enoxaparin administration was associated with lower mortality in patients with D-dimer >2 mg/L or DIC score ≥5.
- Low platelet count and low serum calcium were also related to mortality.
Conclusions:
- Elevated D-dimer levels (>0.5 mg/L) on admission indicate a risk factor for severe COVID-19.
- SIC score (≥4) and DIC score (≥5) can predict mortality in COVID-19 patients.
- Thromboembolic prophylaxis (e.g., enoxaparin) may reduce mortality in specific high-risk patient groups (D-dimer >2 mg/L or DIC score ≥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.
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