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INR and COVID-19 severity and mortality: A systematic review with meta-analysis and meta-regression

Angelo Zinellu1, Panagiotis Paliogiannis2, Ciriaco Carru1

  • 1Department of Biomedical Sciences, University of Sassari, Sassari, Italy.

Advances in Medical Sciences
|July 27, 2021
PubMed

Insights

Elevated International Normalized Ratio (INR) levels are linked to increased severity and mortality in coronavirus disease 2019 (COVID-19) patients. This finding, alongside D-dimer, aids in diagnosing COVID-19 coagulopathy and predicting outcomes.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • D-dimer elevations indicate a pro-thrombotic state in COVID-19, predicting adverse outcomes.
  • The clinical significance of other coagulation markers, like the International Normalized Ratio (INR), in COVID-19 remains less understood.

Purpose of the Study:

  • To systematically review and meta-analyze the association between INR values and COVID-19 severity and mortality.
  • To evaluate the utility of INR as a predictor of clinical outcomes in COVID-19 patients.

Main Methods:

  • A comprehensive literature search was performed in PubMed, Web of Science, and Scopus from January 2020 to February 2021.
  • Included studies reported INR values, COVID-19 severity metrics, and mortality data.
  • Meta-analysis and meta-regression were used to synthesize findings and explore associations with other biomarkers.

Main Results:

  • Thirty-eight studies involving 7440 patients were analyzed.
  • Prolonged INR was significantly associated with severe COVID-19 and non-survivor status (SMD 0.60; 95% CI 0.42 to 0.77; p < 0.001).
  • INR showed significant associations with C-reactive protein and D-dimer levels in meta-regression.

Conclusions:

  • Prolonged INR values are significantly associated with increased COVID-19 severity and mortality.
  • Both INR prolongation and elevated D-dimer levels are valuable tools for diagnosing COVID-19-associated coagulopathy.
  • These markers can aid in predicting clinical outcomes for patients with COVID-19.
Abstract

Keywords:
COVID-19 severityCoagulopathyInternational normalized ratioMortality

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