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2020 ; 7
(9
): e671-e678
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Haematological characteristics and risk factors in the classification and
prognosis evaluation of COVID-19: a retrospective cohort study
#MMPMID32659214
Liao D
; Zhou F
; Luo L
; Xu M
; Wang H
; Xia J
; Gao Y
; Cai L
; Wang Z
; Yin P
; Wang Y
; Tang L
; Deng J
; Mei H
; Hu Y
Lancet Haematol
2020[Sep]; 7
(9
): e671-e678
PMID32659214
show ga
BACKGROUND: COVID-19 is an ongoing global pandemic. Changes in haematological
characteristics in patients with COVID-19 are emerging as important features of
the disease. We aimed to explore the haematological characteristics and related
risk factors in patients with COVID-19. METHODS: This retrospective cohort study
included patients with COVID-19 admitted to three designated sites of Wuhan Union
Hospital (Wuhan, China). Demographic, clinical, laboratory, treatment, and
outcome data were extracted from electronic medical records and compared between
patients with moderate, severe, and critical disease (defined according to the
diagnosis and treatment protocol for novel coronavirus pneumonia, trial version
7, published by the National Health Commission of China). We assessed the risk
factors associated with critical illness and poor prognosis. Dynamic
haematological and coagulation parameters were investigated with a linear mixed
model, and coagulopathy screening with sepsis-induced coagulopathy and
International Society of Thrombosis and Hemostasis overt disseminated
intravascular coagulation scoring systems was applied. FINDINGS: Of 466 patients
admitted to hospital from Jan 23 to Feb 23, 2020, 380 patients with COVID-19 were
included in our study. The incidence of thrombocytopenia (platelet count
<100?×?10(9) cells per L) in patients with critical disease (42 [49%] of 86) was
significantly higher than in those with severe (20 [14%] of 145) or moderate
(nine [6%] of 149) disease (p<0·0001). The numbers of lymphocytes and eosinophils
were significantly lower in patients with critical disease than those with severe
or moderate disease (p<0·0001), and prothrombin time, D-dimer, and fibrin
degradation products significantly increased with increasing disease severity
(p<0·0001). In multivariate analyses, death was associated with increased
neutrophil to lymphocyte ratio (?9·13; odds ratio [OR] 5·39 [95% CI 1·70-17·13],
p=0·0042), thrombocytopenia (platelet count <100?×?10(9) per L; OR 8·33
[2·56-27·15], p=0·00045), prolonged prothrombin time (>16 s; OR 4·94
[1·50-16·25], p=0·0094), and increased D-dimer (>2 mg/L; OR 4·41 [1·06-18·30],
p=0·041). Thrombotic and haemorrhagic events were common complications in
patients who died (19 [35%] of 55). Sepsis-induced coagulopathy and International
Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation
scores (assessed in 12 patients who survived and eight patients who died)
increased over time in patients who died. The onset of sepsis-induced
coagulopathy was typically before overt disseminated intravascular coagulation.
INTERPRETATION: Rapid blood tests, including platelet count, prothrombin time,
D-dimer, and neutrophil to lymphocyte ratio can help clinicians to assess
severity and prognosis of patients with COVID-19. The sepsis-induced coagulopathy
scoring system can be used for early assessment and management of patients with
critical disease. FUNDING: National Key Research and Development Program of
China.