The Relationship Between COVID-19 Related Coagulopathy with Organ Damage and Prognosis

Year 2022, , 342 - 350, 31.12.2022

Özge Özden , Demet Laflı Tunay

https://doi.org/10.36516/jocass.1174534

Abstract

Objective: Coagulopathy and thromboembolic complications are frequently seen in COVID-19. We aimed to evaluate the relationship of coagulopathy with organ dysfunction and mortality in COVID-19.
Methods: COVID-19 patients requiring intensive care for treatment and follow-up were retrospectively analyzed. In the definition of coagulopathy, the International Society on Thrombosis and Hemostasis (ISTH) overt disseminated intravascular coagulation (DIC) scoring system was used. Patients were divided into three groups according to the ISTH scores as follows; patients with no coagulopathy (ISTH score <2), patients with non-evident abnormal coagulation (ISTH score = 2), and patients with evident abnormal coagulation (ISTH score > 2) and mechanical ventilation requirement, acute kidney injury (AKI), acute hepatic injury (AHI) and mortality rates were compared between these groups.
Results: One hundred fifty-five critically ill adult patients with COVID-19 were included in the study. An abnormal coagulation profile developed in 94 (60.6%) patients; of those, 56 (36.1%) patients had non-evident abnormal coagulation, and 38 (24.5%) had evident abnormal coagulation. While there was a significant difference between the groups regarding coagulopathy and development of AKI, requirement for mechanical ventilation, and mortality, no significant difference was found in AHI and length of stay in the intensive care unit. Both mortality and development of AKI increased in correlation with the severity of coagulopathy. ISTH score and development of AKI and AHI were risk factors for both mortality and mechanical ventilation requirement.
Conclusion: COVID-19-related coagulopathy, as determined by the ISTH overt DIC scoring system, is a predictor of organ damage and mortality.

Keywords

Coagulopathy, Coronavirus disease 2019 (COVID-19), Critical illness, Mortality, Organ damage.

References

• 1. Marietta M, Ageno W, Artoni A, et al. COVID-19 and haemostasis: a position paper from Italian Society on Thrombosis and Haemostasis (SISET). Blood Transfus. 2020;18(3):167-9. doi: 10.2450/2020.0083-20.
• 2. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368. doi: 10.1136/bmj.m1091.
• 3. Guan W-j, Ni Z-y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. doi: 10.1056/NEJMoa2002032
• 4. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. doi: 10.1111/jth.14820.
• 5. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-e40. doi: 10.1016/S2352-3026(20)30145-9.
• 6. Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20. doi: 10.1515/cclm-2020-0188.
• 7. Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, Levi M. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. Journal of thrombosis and haemostasis. J Thromb Haemost. 2019;17(11):1989-94. doi: 10.1111/jth.14578.
• 8. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. doi: 10.1038/kisup.2012.1
• 9. Schiff ER, Maddrey WC, Reddy KR. Schiff's Diseases of the Liver: John Wiley & Sons; 2017.
• 10. McGonagle D, O'Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol. 2020;2(7):e437-e45. doi: 10.1016/S2665-9913(20)30121-1.
• 11. Lefrançais E, Ortiz-Muñoz G, Caudrillier A, et al. The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. Nature. 2017;544(7648):105-9. doi: 10.1038/nature21706.
• 12. Thachil J, Cushman M, Srivastava A. A proposal for staging COVID‐19 coagulopathy. Res Pract Thromb Haemost. 2020;4(5):731-6. doi: 10.1002/rth2.12372.
• 13. Iba T, Levy J. Inflammation and thrombosis: roles of neutrophils, platelets and endothelial cells and their interactions in thrombus formation during sepsis. J Thromb Haemost. 2018;16(2):231-41. doi: 10.1111/jth.13911.
• 14. Iba T, Levy JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation. Anesthesiology. 2020;132(5):1238-45. doi: 10.1097/ALN.0000000000003122.
• 15. Gralinski LE, Bankhead III A, Jeng S, et al. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury. MBio. 2013;4(4):e00271-13. doi: 10.1128/mBio.00271-13.
• 16. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3.
• 17. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.
• 18. Spiezia L, Boscolo A, Poletto F, et al. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost. 2020;120(06):998-1000. doi: 10.1055/s-0040-1710018.
• 19. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: 10.1016/S0140-6736(20)30211-7.
• 20. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. doi: 10.1016/S2213-2600(20)30079-5.
• 21. Batlle D, Soler MJ, Sparks MA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. J Am Soc Nephrol. 2020;31(7):1380-3. doi: 10.1681/ASN.2020040419.
• 22. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. doi: 10.1016/j.kint.2020.03.005.
• 23. Mao R, Qiu Y, He J-S, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667-78. doi: 10.1016/S2468-1253(20)30126-6.
• 24. Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020;73(3):566-74. doi: 10.1016/j.jhep.2020.04.006.
• 25. Tsutsumi T, Saito M, Nagai H, et al. Association of coagulopathy with liver dysfunction in patients with COVID‐19. Hepatol Res. 2021;51(2):227-32. doi: 10.1111/hepr.13577.
• 26. Panigada M, Bottino N, Tagliabue P, et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020 Jul;18(7):1738-1742. doi: 10.1111/jth.14850.