The Effectiveness of Platelet and D-Dimer Levels in Predicting Prognosis in Intensive Care Patients Diagnosed With COVID-19

Abstract

Background: The pathophysiology of coagulopathy in patients with Corona virus disease 2019 (COVID-19) and its clinical manifestations remain unclear. However, several studies have reported abnormal coagulation parameters, notably in patients with COVID-19 associated pneumonia and acute respiratory distress syn-drome. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been sug-gested to be a form of disseminated intravascular coagulation. We aimed to determine the predictive value of platelet count and D-dimer levels in predicting prognosis in intensive care patients with a diagnosis of COVID-19.
Materials and Methods: Demographic, clinical, laboratory data and radiological findings were obtained from the hospital electronic patient record using a standard data collection form. Platelet counts and D-dimer data were noted. Intensive care stay, mechanical ventilator duration and hospital stay of the patients were ana-lyzed retrospectively. Clinical data covers also comorbid conditions.
Results: The study included 102 intensive care patients with COVID-19 diagnosis. All the patients had Poly-merase Chain Reaction (PCR) confirmation and abnormalities on chest computed tomography (CT) consistent with COVID-19. Bilateral pneumonia proven by chest CT was reported in 91.2% of the patient. The platelet count of patients who died was median 247x109 /L (min-max 192 - 354), D dimer levels was median 7.03 (min-max 3.36-17.7) mg/L. Patients who living were platelet counts median 310 x109/L (min-max 234 – 350), D-dimer levels median 1.59 (min-max 0.82 -2). There was no statistically significant difference when the platelet count of the survived and deceased patients were compared (p=0.193). But the patients who died was D-dimer levels statistically higher (p=0.001).
Conclusions: High or non-decreasing D-dimer levels may indicate poor prognosis in patients with COVID-19 pneumonia whereas platelet counts don’t have a predictive value.

Keywords

• COVID 19
• intensive care,
• D Dimer

COVID-19 Tanılı Yoğun Bakım Hastalarında Prognozu Öngörmede Platelet ve D-Dimer Düzeylerinin Etkinliği

Abstract

Amaç: Corona Virüs Hastalığı (COVID-19) koagülopatisinin patofizyolojisi ve klinik belirtilerinin altında yatan mekanizma belirsizliğini koruyor. Bununla birlikte, birkaç çalışma, özellikle COVID-19 ile ilişkili pnömoni ve akut solunum sıkıntısı sendromu (ARDS) olan hastalarda anormal pıhtılaşma parametreleri bildirmiştir. COVID-19 koagülopatisinin altında yatan mekanizma bilinmemekle birlikte, bunun bir yaygın damar içi pıhtılaşma (DIC) şekli olduğu öne sürülmüştür. Bu çalışmada, COVID-19 tanılı yoğun bakım hastalarında prognozu öngörmede platelet ve D-dimer düzeylerinin etkinliğini belirlemeyi amaçladık. Yöntem: Demografik, klinik, laboratuvar verileri ve radyolojik bulgular, standart bir veri toplama formu kullanılarak hastane elektronik hasta kayıtlarından elde edildi. Platelet sayıları ve D-dimer verileri kaydedildi. Hastaların hastanede kalış süreleri, mekanik ventilatörde kalış süreleri ve yoğun bakımda kalış süreleri retrospektif olarak incelendi. Bulgular: Çalışmaya COVID-19 tanılı 102 yoğun bakım hastası dahil edildi. Tüm hastalarda Polimeraz Zincir Reaksiyonu(PCR) onayı ve göğüs bilgisayarlı tomografiside (BT) COVID-19 ile uyumlu anormallikler vardı. Göğüs BT ile kanıtlanmış bilateral pnömoni, hastaların %91,2'sinde bildirilmiştir. Ölen hastaların platelet sayısı medyan 247x109 L (min-maks 192 - 354), D dimer seviyesi medyan 7.03 (min-maks 3.36-17.7) mg L-1idi. Yaşayan hastalar platelet sayısı medyan 310 x109 L (min-maks 234 – 350), D-dimer değerleri medyan 1,59 idi (min-maks 0,82 -2). Yaşayan ve ölen hastaların platelet sayıları karşılaştırıldığında istatistiksel olarak anlamlı bir fark yoktu (p=0.193). Ancak ölen hastaların D-dimer düzeyleri istatistiksel olarak daha yüksekti (p= 0.001). Sonuç: Yüksek veya azalmayan D-dimer seviyeleri, COVID-19 pnömonisi olan hastalarda kötü prognozu gösterebilirken trombosit sayılarının öngörücü bir değeri yoktur.

Keywords

• COVID-19
• Yoğun Bakım Ünitesi
• D-Dimer
• Platelet
• COVID-19, Yoğun Bakım Ünitesi, D-Dimer, Platelet

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