key: cord-0953488-v13kzr5y
authors: Xiong, Mi; Liang, Xue; Wei, You‐Dong
title: Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID‐19): a meta‐analysis
date: 2020-05-14
journal: Br J Haematol
DOI: 10.1111/bjh.16725
sha: 39d0a71cc434fd37bb3fc873c2c52cb1b69eb5c3
doc_id: 953488
cord_uid: v13kzr5y

Coronavirus disease 2019 (COVID-19) is widely spread and poses a critical threat to global health (Zhang et al). Prominent changes in coagulation function in severe patients of COVID-19 have been reported in a recent study (Han, et al 2020). Therefore, we conducted this quantitative meta-analysis to explore the difference in blood coagulation parameters between severe and mild cases of COVID-19.

To the Editor:

Coronavirus disease 2019 (COVID-19) is widely spread and poses a critical threat to global health. 1 Prominent changes in coagulation function in severe patients of COVID-19 have been reported in a recent study. 2 Therefore, we conducted this quantitative meta-analysis to explore the difference in blood coagulation parameters between severe and mild cases of COVID-19.

Literature published from December 1, 2019 to March 30, 2020 was searched systematically using PubMed and Embase without language limits. The keywords were: coronavirus, laboratory, clinical manifestations, clinical characteristics, and clinical features. All documents comparing information on coagulation parameters between mild and severe cases of COVID-19 patients were finally referred to in our meta-analysis. The pooled standardised mean difference (SMD) and 95% confidence interval (CI) were computed by applying the random-effect model using Stata software (STATA 14.0, Stata Corp, College Station, TX, USA). The study quality was measured by adopting an 11item checklist, which was suggested by the Agency for Healthcare Research and Quality (AHRQ). Table I displays the main characteristics of the included studies. Nine studies, including one study from medRxiv, with 1105 patients were eventually included for detailed evaluation. Platelet count (PLT), activated partial thromboplastin time (APTT), prothrombin time (PT) and D-dimer (D-D) levels were available in five, six, six and eight studies, respectively. All the studies were conducted in China. Quality score varied from 3 to 7 points, with a mean of 5Á4 (Table I) . All the studies were of moderate quality, except one of low quality.

The main difference in coagulation function between severe and mild COVID-19 patients is shown in Fig 1. Pooled results revealed that PT and D-D levels were significantly higher in patients with severe COVID-19 (0Á68, 95% CI = 0Á43-0Á93, I 2 = 53Á7%; 0Á53, 95% CI = 0Á22-0Á84, I 2 = 78Á9%, respectively). However, no significant difference in PLT and APTT values between severe and mild patients was observed (À0Á08, 95% CI = À0Á34 to 0Á18, I 2 = 60Á5%; À0Á03, 95% CI = À0Á40 to 0Á34, I 2 = 79Á5%, respectively). Increasing values of D-D and PT support the notion that disseminated intravascular coagulation (DIC) may be common in COVID-19 patients. 2 In addition, the rise of D-D level also indicates secondary fibrinolysis conditions in these patients. According to Berri et al., 3 fibrin clot formation helps people to fight against influenza virus infections. Hence, fibrinolysis may potentially induce following severe COVID-19 infection. Future studies should aim to discover more biomarkers of severe cases of COVID-19, and studies exploring the underlying mechanism of deranged coagulation function in COVID-19 are urgently needed. The haemostatic system might be explored for underlying treatment against coronavirus.

Due to the lack of sufficient study data, we cannot perform a more thorough analysis to prove beneficial screening parameters for PLT, APTT, PT and D-D for prediction of severity of COVID-19. However, we suggest that clinical practitioners pay attention to the changes in coagulation function in COVID-19 patients on a daily basis. Subtotal (I 2 = 60·5%, P = 0·038) Subtotal (I 2 = 79·5%, P = 0·000) Subtotal (I 2 = 53·7%, P = 0·055) Subtotal (I 2 = 78·9%, P = 0·000) 

Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan

Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

Plasminogen controls inflammation and pathogenesis of influenza virus infections via fibrinolysis

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia

Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China

Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV

Clinical features and treatment of COVID-19 patients in Northeast Chongqing

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan

Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China

0·52 (−0·15, 1·19) −0·04 (−0·31, 0·24) −0·32 (−0·69, 0·05) −0·45 (−0·84, −0·07) 0·11 (−0·17, 0·39) −0·08 (−0·34, 0·18) 0·31 (−0·10, 0·71) −0·20 (−0·86, 0·46) 0·11 (−0·42, 0·64) 0·52 (0·15, 0·90) −0·40 (−0·78, −0·02)