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Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York:
Morayma Reyes Gil1, Jesus D Gonzalez-Lugo2, Shafia Rahman2
1Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States.
Insights
Early COVID-19 hospitalization in New York revealed that D-Dimer levels, along with absolute neutrophil count and prothrombin time, predict patient mortality. Elevated D-Dimer can assess survival and guide post-discharge care for COVID-19 patients.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- New York City was an early epicenter for the COVID-19 pandemic.
- Understanding coagulopathic presentations and their impact on outcomes is crucial.
Purpose of the Study:
- To investigate the coagulopathic presentation of COVID-19 during the initial surge.
- To determine if hematologic and coagulation parameters predict illness severity and mortality.
Main Methods:
- Retrospective case study of 225 adult inpatients with COVID-19.
- Analysis of demographic, clinical, and laboratory data, including D-Dimer, PT, and ANC.
- Logistic regression to assess the predictive value of parameters for mortality.
Main Results:
- Admission D-Dimer, ANC, and PT significantly differentiated between survivors and non-survivors.
- An initial D-Dimer level of 2.1 μg/mL was optimal for predicting mortality.
- Elevated D-Dimer within 48 hours of admission increased mortality risk.
Conclusions:
- Initial and maximum D-Dimer values are effective biomarkers for assessing COVID-19 patient survival.
- D-Dimer can aid in monitoring discharged patients for potential complications.
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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