Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4370-4379
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4370
Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients
Lang Wang, Wen-Bo He, Xiao-Mei Yu, Da-Long Hu, Hong Jiang
Lang Wang, Wen-Bo He, Xiao-Mei Yu, Hong Jiang, Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Lang Wang, Wen-Bo He, Xiao-Mei Yu, Hong Jiang, Cardiovascular Research Institute, Wuhan University, Wuhan 430060, Hubei Province, China
Lang Wang, Wen-Bo He, Xiao-Mei Yu, Hong Jiang, Hubei Key Laboratory of Cardiology, Wuhan 430060, Hubei Province, China
Da-Long Hu, School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney 2052, Australia
Author contributions: Wang L and He WB drafted the manuscript; Jiang H and Wang L conceived the idea; Wang L, He WB and Yu XM reviewed the medical records and collected the data; Hu DL performed the statistical analysis and reviewed the manuscript; Jiang H reviewed the manuscript; All authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81570450 and No. 81900455.
Institutional review board statement: This study was reviewed and approved by the National Natural Science Foundation of China.
Informed consent statement: The National Natural Science Foundation of China waived the informed consent for this study.
Conflict-of-interest statement: There is no conflict of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong Jiang, MD, Chief Physician, Director, Full Professor, Department of Cardiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, District of Wuchang, Wuhan 430060, Hubei Province, China. hong-jiang@whu.edu.cn
Received: April 28, 2020
Peer-review started: April 28, 2020
First decision: May 21, 2020
Revised: June 2, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: October 6, 2020
Processing time: 152 Days and 10.8 Hours
Abstract
BACKGROUND

The prognostic value of coagulation disorder in coronavirus disease 2019 (COVID-19) patients should be demonstrated.

AIM

To investigate the abnormalities of coagulation parameters in the patients with COVID-19 and their prognostic values.

METHODS

Consecutive patients admitted in the isolation ward of Renmin Hospital of Wuhan University from January 31 to February 5, 2020 with confirmed COVID-19 were included. The primary outcomes were death and survival as of March 11. Demographics, vital signs, comorbidities and laboratory tests were collected and compared between those who died and survivors. Logistic regression analysis for prognostic factors was performed. Kaplan-Meier analysis was used to compare the estimated survival rate between patients with prolonged prothrombin time and normal prothrombin time.

RESULTS

The total number of patients with confirmed COVID-19 who were enrolled was 213. The median age was 62 years, and 95 patients (44.6%) were men. Fifty-one patients were critical (23.9%), 79 patients were severe (37.1%) and 83 patients were moderate (39%). As of March 11, 2020, 99 patients were discharged (46.5%), 79 patients (37.1%) stayed in the hospital and 35 patients (16.2%) died. Median time to death was 6 (4-8) d, while median hospital stay was 32 (22-36) d in survivors (P < 0.001). More men (P = 0.002) and elderly patients (P < 0.001) were found in the group of those who died. The respiration rate at admission was higher in the group of those who died (P < 0.001). The incidences of hypertension (P = 0.028), cerebrovascular disease (P < 0.001), chronic kidney disease (P = 0.02) and chronic obstructive pulmonary disease (P < 0.001) were higher in the group of those who died. Platelet count was decreased in the group of those who died (P = 0.002) whereas prothrombin time (P < 0.001), activated partial thromboplastin time (P = 0.033), concentration of D-dimer (P < 0.001) and fibrin degradation products (P < 0.001) were increased in the group of those who died. Prothrombin time [odds ratio (OR): 2.19, P = 0.004], respiration rate (OR: 1.223, P < 0.001), age (OR: 1.074, P < 0.001) and fibrin degradation products concentration (OR: 1.02, P = 0.014) were predictors of death. The survival rate was significantly lower in patients with prolonged prothrombin time compare to those with normal prothrombin time (P < 0.001).

CONCLUSION

Prothrombin time, concentration of fibrin degradation products, respiration rate and age were predictive factors for clinical outcomes of COVID-19 patients.

Keywords: COVID-19; Coagulation; Prothrombin time; Fibrin degradation products; Prognosis; Infectious disease

Core Tip: Coagulation disorders were significantly more common in the patients who died with coronavirus disease 2019 than the survivors. Prothrombin time (PT), concentration of fibrin degradation products, respiration rate and age were predictive factors for fatal outcome. The fatality of patients with prolonged PT at admission was significantly higher than those with normal PT. Patients with prolonged PT at admission should be paid more attention to and treated with caution.