机构：[1]Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.[2]State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.[3]Department of Tuberculosis and Respiratory Disease, Wuhan Jinyintan Hospital, 430023, Wuhan, China.[4]Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.浙江大学医学院附属第一医院[5]Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.[6]Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China.首都医科大学宣武医院[7]Department of Critical Care Medicine, Zhongda Hospital, Southeast University, 210009, Nanjing, China.[8]Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, 350025, FuZhou, China.[9]Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China.[10]Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China.[11]Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China.[12]Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, 430023, Wuhan, Hubei, China.[13]Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. tanhuo.2008@163.com.[14]State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. nanshan@vip.163.com.[15]Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. xdluo@gzhmu.edu.cn.[16]State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China. sonysang999@aliyun.com.
Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases.
We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020.
Of 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of > 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of > 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was > 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality.
A D-dimer concentration of > 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of > 4 and DIC score of > 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of > 2 mg/L or DIC score of ≥ 5.
