Mitra Saikat, Ling Ryan Ruiyang, Yang Isabelle Xiaorui, Poon Wynne Hsing, Tan Chuen Seng, Monagle Paul, MacLaren Graeme, Ramanathan Kollengode
Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore.
Ann Acad Med Singap. 2021 Apr;50(4):325-335. doi: 10.47102/annals-acadmedsg.2020420.
Coronavirus disease 2019 (COVID-19)-induced coagulopathy (CIC) has been widely reported in the literature. However, the spectrum of abnormalities associated with CIC has been highly variable.
We conducted a systematic review of the literature (until 1 June 2020) to assess CIC and disease severity during the early COVID-19 pandemic. Primary outcomes were pooled mean differences in platelet count, D-dimer level, prothrombin time, activated partial thromboplastin time (aPTT) and fibrinogen level between non-severe and severe patients, stratified by degree of hypoxaemia or those who died. The risk factors for CIC were analysed. Random-effects meta-analyses and meta-regression were performed using R version 3.6.1, and certainty of evidence was rated using the Grading of Recommendation, Assessment, Development, and Evaluation approach.
Of the included 5,243 adult COVID-19 patients, patients with severe COVID-19 had a significantly lower platelet count, and higher D-dimer level, prothrombin time and fibrinogen level than non-severe patients. Pooled mean differences in platelet count (-19.7×109/L, 95% confidence interval [CI] -31.7 to -7.6), D-dimer level (0.8μg/mL, 95% CI 0.5-1.1), prothrombin time (0.4 second, 95% CI 0.2-0.6) and fibrinogen level (0.6g/L, 95% CI 0.3-0.8) were significant between the groups. Platelet count and D-dimer level were significant predictors of disease severity on meta-regression analysis. Older men had higher risks of severe coagulopathic disease.
Significant variability in CIC exists between non-severe and severe patients, with platelet count and D-dimer level correlating with disease severity. Routine monitoring of all coagulation parameters may help to assess CIC and decide on the appropriate management.
2019年冠状病毒病（COVID-19）所致凝血病（CIC）在文献中已有广泛报道。然而，与CIC相关的异常谱差异很大。
我们对文献（截至2020年6月1日）进行了系统综述，以评估COVID-19大流行早期的CIC和疾病严重程度。主要结局是按低氧血症程度或死亡患者分层的非重症和重症患者之间血小板计数、D-二聚体水平、凝血酶原时间、活化部分凝血活酶时间（aPTT）和纤维蛋白原水平的合并平均差异。分析了CIC的危险因素。使用R 3.6.1版进行随机效应荟萃分析和荟萃回归，并采用推荐分级、评估、制定和评价方法对证据的确定性进行评级。
在纳入的5243例成年COVID-19患者中，重症COVID-19患者的血小板计数显著低于非重症患者，D-二聚体水平、凝血酶原时间和纤维蛋白原水平则高于非重症患者。两组间血小板计数（-19.7×10⁹/L，95%置信区间[CI]-31.7至-7.6）、D-二聚体水平（0.8μg/mL，95%CI 0.5-1.1）、凝血酶原时间（0.4秒，95%CI 0.2-0.6）和纤维蛋白原水平（0.6g/L，95%CI 0.3-0.8）的合并平均差异具有统计学意义。荟萃回归分析显示，血小板计数和D-二聚体水平是疾病严重程度的显著预测因素。老年男性发生严重凝血病的风险较高。
非重症和重症患者的CIC存在显著差异，血小板计数和D-二聚体水平与疾病严重程度相关。对所有凝血参数进行常规监测可能有助于评估CIC并决定适当的治疗方案。
