Wang Lang, He Wen-Bo, Yu Xiao-Mei, Hu Da-Long, Jiang Hong
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China.
School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney 2052, Australia.
World J Clin Cases. 2020 Oct 6;8(19):4370-4379. doi: 10.12998/wjcc.v8.i19.4370.
The prognostic value of coagulation disorder in coronavirus disease 2019 (COVID-19) patients should be demonstrated.
To investigate the abnormalities of coagulation parameters in the patients with COVID-19 and their prognostic values.
Consecutive patients admitted in the isolation ward of Renmin Hospital of Wuhan University from January 31 to February 5, 2020 with confirmed COVID-19 were included. The primary outcomes were death and survival as of March 11. Demographics, vital signs, comorbidities and laboratory tests were collected and compared between those who died and survivors. Logistic regression analysis for prognostic factors was performed. Kaplan-Meier analysis was used to compare the estimated survival rate between patients with prolonged prothrombin time and normal prothrombin time.
The total number of patients with confirmed COVID-19 who were enrolled was 213. The median age was 62 years, and 95 patients (44.6%) were men. Fifty-one patients were critical (23.9%), 79 patients were severe (37.1%) and 83 patients were moderate (39%). As of March 11, 2020, 99 patients were discharged (46.5%), 79 patients (37.1%) stayed in the hospital and 35 patients (16.2%) died. Median time to death was 6 (4-8) d, while median hospital stay was 32 (22-36) d in survivors ( < 0.001). More men ( = 0.002) and elderly patients ( < 0.001) were found in the group of those who died. The respiration rate at admission was higher in the group of those who died ( < 0.001). The incidences of hypertension ( = 0.028), cerebrovascular disease ( < 0.001), chronic kidney disease ( = 0.02) and chronic obstructive pulmonary disease ( < 0.001) were higher in the group of those who died. Platelet count was decreased in the group of those who died ( = 0.002) whereas prothrombin time ( < 0.001), activated partial thromboplastin time ( = 0.033), concentration of D-dimer ( < 0.001) and fibrin degradation products ( < 0.001) were increased in the group of those who died. Prothrombin time [odds ratio (OR): 2.19, = 0.004], respiration rate (OR: 1.223, < 0.001), age (OR: 1.074, < 0.001) and fibrin degradation products concentration (OR: 1.02, = 0.014) were predictors of death. The survival rate was significantly lower in patients with prolonged prothrombin time compare to those with normal prothrombin time ( < 0.001).
Prothrombin time, concentration of fibrin degradation products, respiration rate and age were predictive factors for clinical outcomes of COVID-19 patients.
应阐明凝血功能障碍对2019冠状病毒病（COVID-19）患者的预后价值。
探讨COVID-19患者凝血参数异常及其预后价值。
纳入2020年1月31日至2月5日在武汉大学人民医院隔离病房收治的确诊COVID-19连续病例。主要结局为截至3月11日的死亡和存活情况。收集死亡患者和存活患者的人口统计学资料、生命体征、合并症及实验室检查结果并进行比较。对预后因素进行逻辑回归分析。采用Kaplan-Meier分析比较凝血酶原时间延长患者和凝血酶原时间正常患者的估计生存率。
纳入确诊COVID-19患者共213例。中位年龄为62岁，男性95例（44.6%）。危重型51例（23.9%），重型79例（37.1%），中型83例（39%）。截至2020年3月11日，99例出院（46.5%），79例（37.1%）住院，35例（16.2%）死亡。死亡患者的中位死亡时间为6（4 - 8）天，存活患者的中位住院时间为32（22 - 36）天（P < 0.001）。死亡组男性更多（P = 0.002），老年患者更多（P < 0.001）。死亡组入院时呼吸频率更高（P < 0.001）。死亡组高血压（P = 0.028）、脑血管疾病（P < 0.001）、慢性肾脏病（P = 0.02）及慢性阻塞性肺疾病（P < 0.001）的发生率更高。死亡组血小板计数降低（P = 0.002），而凝血酶原时间（P < 0.001）、活化部分凝血活酶时间（P = 0.033）、D-二聚体浓度（P < 0.001）及纤维蛋白降解产物（P < 0.001）升高。凝血酶原时间[比值比（OR）：2.19，P = 0.004]、呼吸频率（OR：1.223，P < 0.001）、年龄（OR：1.074，P < 0.001）及纤维蛋白降解产物浓度（OR：1.02，P = 0.014）是死亡的预测因素。凝血酶原时间延长的患者生存率显著低于凝血酶原时间正常的患者（P < 0.001）。
凝血酶原时间、纤维蛋白降解产物浓度、呼吸频率及年龄是COVID-19患者临床结局的预测因素。
