Reyes Gil Morayma, Gonzalez-Lugo Jesus D, Rahman Shafia, Barouqa Mohammad, Szymanski James, Ikemura Kenji, Lo Yungtai, Billett Henny H
Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States.
Division of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, United States.
Front Physiol. 2021 Feb 23;12:618929. doi: 10.3389/fphys.2021.618929. eCollection 2021.
COVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020.
To investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death.
Retrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020.
Montefiore Health System main hospital, Moses, a large tertiary care center in the Bronx.
Adult inpatients with positive COVID tests hospitalized at MHS.
Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data.
Relationship and predictive value of measured parameters to mortality and illness severity.
Of the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged).
We describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.
新型冠状病毒肺炎（COVID-19）已引发全球疫情，2020年3月中旬至5月期间，纽约成为美国COVID-19的疫情中心。
调查纽约COVID-19疫情激增早期阶段COVID的凝血异常表现及其自然病程。调查血液学和凝血参数是否可用于评估疾病严重程度和死亡情况。
对2020年3月20日至3月31日期间COVID阳性住院患者进行回顾性病例研究。
蒙特菲奥里医疗系统的主要医院摩西医院，位于布朗克斯区的一家大型三级医疗中心。
在蒙特菲奥里医疗系统住院且COVID检测呈阳性的成年患者。
查询参与者的数据集，获取人口统计学信息（年龄、性别、社会经济地位以及自我报告的种族和/或族裔）、临床和实验室数据。
所测参数与死亡率和疾病严重程度的关系及预测价值。
在本次病例回顾的225名患者中，75人在住院期间死亡，150人出院回家。只有入院时的凝血酶原时间（PT）、绝对中性粒细胞计数（ANC）和首次D-二聚体能够显著区分存活出院者和死亡者。逻辑回归分析显示，入院后48小时内首次D-二聚体升高会增加死亡几率。发现初始D-二聚体预测死亡率的最佳切点为2.1μg/mL。15%的出院患者需要再次入院，且超过三分之一的再次入院患者死亡（占所有初始出院患者的5%）。
我们在此全面评估了COVID-19患者的血液学和凝血参数，并研究了这些参数与死亡率的关系。我们证明，初始和最高D-二聚体值均为可用于生存评估的生物标志物。此外，D-二聚体可能有助于对出院患者进行随访。
