Research Paper Advance Articles

Coagulation dysfunction in ICU patients with coronavirus disease 2019 in Wuhan, China: A retrospective observational study of 75 fatal cases

Jiaran Shi1, *, , Wang Zhang2, *, , Ling Sang3, *, , Zhaohui Qu4, *, , Ming Zhong5, , Li jiang6, , Bin Song7, , Liang Kang4, , Yun Zhang8, , Xingxiang Wang1, , Dingyu Zhang9,10, , Xia Zheng8, ,

  • 1 Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
  • 2 Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
  • 3 Department of Critical Care Medicine, The First Affiliated Hospital of GuangZhou Medical University, GuangZhou Institute of Respiratory Health, Guangzhou, Guangdong, PR China
  • 4 Department of Critical Care Medicine, Jinyintan Hospital, Wuhan, Hubei, PR China
  • 5 Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, PR China
  • 6 Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, PR China
  • 7 Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, Hubei, PR China
  • 8 Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
  • 9 Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Hubei, PR China
  • 10 Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Hubei, PR China
* Equal contribution

Received: August 24, 2020       Accepted: October 27, 2020       Published: December 9, 2020      

https://doi.org/10.18632/aging.202223
How to Cite

Copyright: © 2020 Shi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Coagulation dysfunction in critically ill patients with coronavirus disease 2019 (COVID-19) has not been well described, and the efficacy of anticoagulant therapy is unclear. In this study, we retrospectively reviewed 75 fatal COVID-19 cases who were admitted to the intensive care unit at Jinyintan Hospital (Wuhan, China). The median age of the cases was 67 (62–74) years, and 47 (62.7%) were male. Fifty patients (66.7%) were diagnosed with disseminated intra-vascular coagulation. Approximately 90% of patients had elevated D-dimer and fibrinogen degradation products, which decreased continuously after anticoagulant treatment and was accompanied by elevated albumin (all P<0.05). The median survival time of patients treated with anticoagulant was 9.0 (6.0–14.0) days compared with 7.0 (3.0–10.0) days in patients without anticoagulant therapy (P=0.008). After anticoagulation treatment, C-reactive protein levels decreased (P=0.004), as did high-sensitivity troponin (P=0.018), lactate dehydrogenase (P<0.001), and hydroxybutyrate dehydrogenase (P<0.001). In conclusion, coagulation disorders were widespread among fatal COVID-19 cases. Anticoagulant treatment partially improved hypercoagulability, prolonged median survival time, and may have postponed inflammatory processes and cardiac injury.

Abbreviations

COVID-19: coronavirus disease 2019; ICUs: intensive care units; IQR: interquartile range; WBC: white blood cell; RBC: red blood cell; HGB: hemoglobin; PLT: platelet; CRP: c-reactive protein; PCT: procalcitonin; FDP: fibrinogen degradation products; Fbg: fibrinogen; TT: thromboplastin time; PT: prothrombin time; PTA: PT activity; APTT: activated partial TT; AT-III: antithrombin III; DIC: disseminated intra-vascular coagulation; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; Cr: creatinine; IL: interleukin; hsTNI: high-sensitivity troponin; LDH: lactic dehydrogenase; HBDH: hydroxybutyrate dehydrogenase; CK: creatine kinase; CK-MB: creatine kinase-MB; JAAM: Japanese Association for Acute Medicine; SOFA: sequential organ failure assessment; HFNC: High flow nasal cannula; NIV: noninvasive ventilation; IMV: invasive mechanical ventilation; ECMO: extracorporeal membrane oxygenation; LMWH: low molecular weight heparin.