J Med Virol. 2020 Jul 24. doi: 10.1002/jmv.26346. Online ahead of print.
BACKGROUND: The outbreak of 2019 novel coronavirus disease (COVID-19) has posed a grave threat to the global public health. The COVID-19-induced infection is closely related to coagulation dysfunction in the affected patients. This paper attempts to conduct a meta-analysis and systematically review the blood coagulation indicators in severe COVID-19 patients.
METHODS: A meta-analysis of eligible studies was performed to compare the blood coagulation indicators in severe and non-severe COVID-19 patients. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies published between December 1, 2019 and May 7, 2020.
RESULTS: A total of 13 studies with 1,341 adult patients were enrolled in this analysis. Platelet [WMD=-24.83, 95% CI (-34.12, -15.54), p<0.001], d-dimer [WMD=0.19, 95% CI (0.09, 0.29), p<0.001] and fibrinogen [WMD=1.02, 95% CI (0.50, 1.54), p<0.001] were significantly associated with the severity in COVID-19 patients. The meta-analysis revealed that no correlation was evident between an increased severity risk of COVID-19 and activated partial thromboplastin time (APTT) [WMD=-1.56, 95% CI (-5.77, 2.64), p=0.468] or prothrombin time (PT) [WMD=0.19, 95% CI (-0.13, 0.51), p=0.243]. The single arm meta-analysis showed that, compared with the non-severe group, the severe group had a lower pooled platelet [165.12 (95% CI: 157.38-172.85) vs. 190.09 (95% CI: 179.45-200.74)], higher d-dimer [0.49 (95% CI: 0.33-0.64) vs. 0.27 (95% CI: 0.20-0.34)] and higher fibrinogen [4.34 (95% CI: 1.98-6.70) vs. 3.19 (95% CI: 1.13-5.24)].
CONCLUSIONS: Coagulation dysfunction is closely related to the severity of COVID-19 patients, in which low platelet, high d-dimer and fibrinogen upon admission may serve as risk indicators for increased aggression of the disease. These findings are of great clinical value for timely and effective treatment of the COVID-19 cases. This article is protected by copyright. All rights reserved.