Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients

Coronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD-2.15 [-2.73 to-1.56], I-2 98%, P<0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD-2.91 [-3.87 to-1.96], I-2 98%, P<0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I-2 96%, P<0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I-2 97%, P<0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD-1.34 [-2.06 to-0.62], I-2 98%, P<0.0002) and Survivors groups (SMD-1.61 [-2.69 to-0.54], I-2 98%, P<0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.

Automated summary

The study found that severe COVID-19 infection is associated with higher D-dimer values, lower platelet count, and prolonged prothrombin time. These results suggest a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.