Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Key laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang, China.
Department of Molecular and Cell Biology, Department of Statistics, College of Letters and Science, University of California, Berkeley, California, United States.
Thromb Haemost. 2020 Nov;120(11):1524-1535. doi: 10.1055/s-0040-1714369. Epub 2020 Jul 17.
The aim of this meta-analysis is to assess the prevalence of coagulation dysfunction in Chinese COVID-19 patients and to determine the association of coagulopathy with the severity and prognosis of COVID-19.
A meta-analysis of the prevalence of different abnormal coagulation indicators in COVID-19 patients in China was performed. The difference of coagulation indicators and the incidence of DIC were compared between severe cases and nonsevere cases as well as nonsurvivors and survivors, respectively.
A total of 22 Chinese studies involving 4,889 confirmed COVID-19 inpatients were included. The average D-dimer value of COVID-19 patients is 0.67 µg/mL (95% confidence interval [CI]: 0.56-0.78), and 29.3% (95% CI: 20.1-38.5%) of patients showed elevated D-dimer values. Severe patients had significantly higher D-dimer levels and prolonged prothrombin time (PT) compared with nonsevere patients. Nonsurvivors had significantly higher D-dimer levels, prolonged PT, and decreased platelet count compared with survivors. In total, 6.2% (95% CI: 2.6-9.9%) COVID-19 patients were complicated by disseminated intravascular coagulation (DIC), in which the log risk ratio in nonsurvivors was 3.267 (95% CI: 2.191-4.342, = 5.95, < 0.05) compared with that in survivors.
The prevalence of coagulopathy in Chinese COVID-19 inpatients is high, and both the abnormal coagulation indicators and DIC are closely associated with the severity and poor prognosis of these COVID-19 patients. Therefore, attention should be paid to coagulation dysfunction in COVID-19 patients. Closely monitoring of coagulation indicators and application of appropriate anticoagulation may improve the prognosis of COVID-19 inpatients in China.
本荟萃分析旨在评估中国 COVID-19 患者凝血功能障碍的发生率，并确定凝血异常与 COVID-19 严重程度和预后的关系。
对中国 COVID-19 患者不同异常凝血指标的患病率进行荟萃分析。分别比较重症与非重症病例以及死亡与存活病例的凝血指标差异和 DIC 发生率。
共纳入 22 项中国研究，涉及 4889 例确诊 COVID-19 住院患者。COVID-19 患者平均 D-二聚体值为 0.67μg/mL（95%可信区间[CI]：0.56-0.78），29.3%（95% CI：20.1-38.5%）的患者存在 D-二聚体升高。重症患者的 D-二聚体水平和凝血酶原时间（PT）明显高于非重症患者。与存活者相比，死亡者的 D-二聚体水平更高，PT 延长，血小板计数降低。共有 6.2%（95% CI：2.6-9.9%）的 COVID-19 患者并发弥漫性血管内凝血（DIC），其中死亡者的对数风险比为 3.267（95% CI：2.191-4.342， = 5.95， < 0.05），高于存活者。
中国 COVID-19 住院患者凝血功能障碍的发生率较高，异常凝血指标和 DIC 均与 COVID-19 患者的严重程度和不良预后密切相关。因此，应关注 COVID-19 患者的凝血功能障碍。密切监测凝血指标并应用适当的抗凝治疗可能会改善中国 COVID-19 住院患者的预后。
