Coagulation abnormalities compromise COVID-19 survival

Patients with abnormalities in coagulation parameters such as prothrombin concentration (PC) and D-dimer (DD) levels are at greater risk of more severe COVID-19 infection and subsequent death, reports a recent study.

Researchers conducted a prospective analysis of 267 patients with newly diagnosed COVID-19. Aside from PC and DD, other coagulation parameters measured included fibrinogen, antithrombin III (ATIII), and activated partial thromboplastin time (aPTT). Endpoints were COVID-19 severity and clinical outcomes, assessed according to coagulation parameters.

Of the participants, 144 were admitted to the hospital while 123 were not; in terms of severity, majority (n=196) had nonsevere disease, while the remaining 71 were deemed to have severe COVID-19.

Logistic regression analysis revealed that ATIII was a significant indicator of severe illness (odds ratio [OR], 0.89, 95 percent confidence interval [CI], 0.84­­–0.95; p<0.001), as was DD (OR, 5.95, 95 percent CI, 3.44–10.3; p<0.001). Lactate dehydrogenase, a marker for tissue damage and some infections, also correlated significantly with severe illness (OR, 1.008, 95 percent CI, 1.004–1.01; p<0.001).

Coagulation abnormalities were likewise correlated with death. Patients with such abnormalities saw a 7.2-percent death rate despite aggressive therapy, as compared with only 0.59 percent in comparators with normal coagulation parameters. Indicators including aPTT, fibrinogen, DD, and ferritin were all elevated in those who died; in contrast, ATIII was considerably suppressed.

“Early assessment and dynamic monitoring of coagulation system parameters may be a benchmark in the control of COVID-19 severity and death,” the researchers said.