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Can disseminated intravascular coagulation scores predict mortality in COVID-19 patients?

Nimra Anwar1, Sunila Tashfeen1, Fahim Akhtar1

  • 1Department of Pathology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan.

Journal of Taibah University Medical Sciences
|April 14, 2021
PubMed

Insights

Disseminated intravascular coagulation (DIC) is common in COVID-19 non-survivors, with non-overt DIC seen in 94.8%. D-dimer and prothrombin time are more reliable indicators of mortality than the ISTH DIC score in these patients.

Area of Science:

  • Medical Research
  • Hematology
  • Infectious Diseases

Background:

  • Complications of COVID-19 can lead to disseminated intravascular coagulation (DIC).
  • DIC is a known cause of mortality in patients with COVID-19.
  • Understanding DIC incidence and predictors in non-survivors is crucial.

Purpose of the Study:

  • To analyze the incidence of DIC in COVID-19 non-survivors.
  • To assess the association between DIC and its comorbidities.
  • To identify reliable indicators of mortality in COVID-19 non-survivors with DIC.

Main Methods:

  • Retrospective analysis of medical records of 154 COVID-19 non-survivors.
  • Application of International Society on Thrombosis and Haemostasis (ISTH) criteria for DIC diagnosis.
  • Receiver-operating characteristic (ROC) analysis to assess the association between DIC and comorbidities.

Main Results:

  • Non-overt DIC observed in 94.8% of patients; overt DIC in 5.2%.
  • Mortality rate was 4.5 times higher in men than women.
  • Thrombotic event and chronic kidney disease were significant predictors of DIC (p < 0.0001 and p = 0.03).
  • Elevated D-dimer and prolonged prothrombin time (PT) were noted in non-survivors.

Conclusions:

  • The ISTH DIC score may not reliably predict mortality in COVID-19 patients.
  • COVID-19-related DIC appears to differ from sepsis-induced DIC.
  • Increased D-dimer and prolonged PT are more reliable indicators of mortality in seriously ill COVID-19 non-survivors with comorbidities.
Abstract

Keywords:
COVID-19Disseminated intravascular coagulationMortalityProthrombin timeSepsis

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