Thrombocytopenia and increased risk of adverse outcome in COVID-19 patients

PeerJ. 2022 Jun 30:10:e13608. doi: 10.7717/peerj.13608. eCollection 2022.

Abstract

Background: Thrombocytopenia was common in the coronavirus disease 2019 (COVID-19) patients during the infection, while the role of thrombocytopenia in COVID-19 pathogenesis and its relationship with systemic host response remained obscure. The study aimed to systematically evaluate the relationship between thrombocytopenia in COVID-19 patients and clinical, haematological and biochemical markers of the disease as well as adverse outcomes.

Methods: To assess the relationship between abnormal platelet levels and disease progression, a multi-center retrospective cohort study was conducted. COVID-19 patients with thrombocytopenia and a sub-cohort of matched patients without thrombocytopenia were compared for their clinical manifestations, haematological disorders, biochemical parameters, inflammatory markers and clinical outcome.

Results: Thrombocytopenia was present in 127 of 2,209 analyzed patients on admission. Compared with the control group, thrombocytopenia patients developed significantly higher frequency of respiratory failure (41.9% vs. 22.6%, P = 0.020), intensive care unit entrance (25.6% vs. 11.5%, P = 0.012), disseminated intravascular coagulation (45.2% vs. 10.6%, P < 0.001), more altered platelet morphology indexes and coagulation perturbation, higher levels of inflammatory markers. In addition, a significantly increased all-cause mortality (hazard ratio 3.08, 95% confidence interval 2.26-4.18, P < 0.001) was also observed in the patients with thrombocytopenia. Late development of thrombocytopenia beyond 14 days post-symptom was observed in 61 patients, from whom a comparable mortality rate yet longer duration to death was observed compared to those with early thrombocytopenia.

Conclusions: Our finding from this study adds to previous evidence that thrombocytopenia is associated with adverse outcome of the disease and recommend that platelet count and indices be included alongside other haematological, biochemical and inflammatory markers in COVID-19 patients' assessment during the hospital stay.

Keywords: Adverse outcome; COVID-19; China; Mortality; Thrombocytopenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19* / complications
  • Disseminated Intravascular Coagulation* / etiology
  • Humans
  • Platelet Count
  • Retrospective Studies
  • Thrombocytopenia* / epidemiology

Grants and funding

This study was supported by the China Mega-Project for Infectious Diseases grant (2018ZX10713002, 2018ZX10101003, 2017ZX10103004) and the Natural Science Foundation of China (81825019). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.