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Thromb Haemost 2020; 120(11): 1524-1535
DOI: 10.1055/s-0040-1714369
Coagulation and Fibrinolysis

Prevalence and Impact of Coagulation Dysfunction in COVID-19 in China: A Meta-Analysis

Shanen Jin‡   *
1   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
,
Yiyang Jin‡   *
2   Department of Molecular and Cell Biology, Department of Statistics, College of Letters and Science, University of California, Berkeley, California, United States
,
Bai Xu
3   Department of Clinical Medicine, Bengbu Medical College Graduate School, Bengbu, Anhui, China
,
Jun Hong
4   Department of Critical Care Medicine, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
,
Xianghong Yang
4   Department of Critical Care Medicine, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
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Abstract

Background 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.

Methods 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.

Results 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, Z = 5.95, p < 0.05) compared with that in survivors.

Conclusion 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.

Keywords

COVID-19 - coagulopathy - disseminated intravascular coagulation - venous thromboembolism - anticoagulation

Authors' Contributions

All the authors have participated in literature retrieval and viewpoint discussion in this article. S.J. and Y.J. contributed in writing this article. Y.J. did the statistics. X.Y. revised the article. All authors read and approved the final manuscript.


Note

The study does not require ethical approval because the meta-analysis is based on published research and the original data are anonymous.


* These authors contributed equally to this article.


Supplementary Material



Publikationsverlauf

Eingereicht: 15. Mai 2020

Angenommen: 26. Juni 2020

Artikel online veröffentlicht:
17. Juli 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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