COVID-19 coagulopathy: An in-depth analysis of the coagulation system

Eur J Haematol. 2020 Dec;105(6):741-750. doi: 10.1111/ejh.13501. Epub 2020 Aug 19.

Abstract

Background: Abnormal coagulation parameters have been reported in COVID-19-infected patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC).

Objectives: The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine whether coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease.

Patients/methods: Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes.

Results: The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/mL; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9), and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; P = .002).

Conclusions: COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC.

Keywords: COVID-19; D-dimer; SARS-CoV-2 infection; coagulation factors; coagulopathy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus / pathogenicity*
  • Biomarkers / blood
  • Blood Coagulation Tests
  • Blood Platelets / pathology
  • Blood Platelets / virology
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / mortality
  • Coronavirus Infections / virology
  • Cytokine Release Syndrome / complications*
  • Cytokine Release Syndrome / diagnosis
  • Cytokine Release Syndrome / mortality
  • Cytokine Release Syndrome / virology
  • Disseminated Intravascular Coagulation / complications*
  • Disseminated Intravascular Coagulation / diagnosis
  • Disseminated Intravascular Coagulation / mortality
  • Disseminated Intravascular Coagulation / virology
  • Factor VIII / metabolism*
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Humans
  • Lung / blood supply
  • Lung / drug effects
  • Lung / pathology
  • Lung / virology
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / virology
  • Prognosis
  • Protein S / metabolism
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index
  • Survival Analysis
  • Venous Thrombosis / complications*
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / mortality
  • Venous Thrombosis / virology

Substances

  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • PROS1 protein, human
  • Protein S
  • fibrin fragment D
  • Factor VIII