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

Öz

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.

Anahtar Kelimeler

• COVID 19
• intensive care,
• D Dimer

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1- Bastug A, Bodur H, Erdogan S, et.al. Clinical and laboratory features of COVID- 19: Predictors of severe prognosis. Int Immunopharmacol 2020;88:e106950.
2. 2- Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395 (10224):565–74.
3. 3- Sohrabi C, Alsafi Z, O'Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int. J. Surg 2020; 76:71–6.
4. 4- Sun X, Wang T, Cai D, et al. Cytokine storm intervention in the early stages of COVID-19 pneumonia. Cytokine Growth Factor Rev 2020; 53:38–42.
5. 5- Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost 2020;18 (7): 1747–51.
6. 6- Whiteman SC, Bianco A, Knight RA, Spiteri MA. Human rhinovirus selectively modulates membranous and soluble forms of its intercellular adhesion molecule-1 (ICAM-1) receptor to promote epithelial cell infectivity. J Biol Chem 2003 4; 278(14): 11954–61.
7. 7- Svartengren M, Falk R, Philipson K. Long-term clearance from small airways decreases with age. Eur Respir J 2005; 26(4):609–15.
8. 8- Cao W, Li T. COVID-19: towards understanding of pathogenesis. Cell Res 2020; 30(5):367–9.

9. 9- Wang D, Yin Y, Hu C, et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care 2020; 24 (1):188.
10. 10- Du Y, Tu L, Zhu P, et al. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. Am J Respir Crit Care Med 2020; 201(11):1372–9.
11. 11- Wang Y, You XY, Wang YJ, et al. Estimating the basic reproduction number of COVID-19 in Wuhan, China. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41(4):476–9.
12. 12- Roy J, Jain R, Golamari R, Vunnam R, Sahu N. COVID-19 in the geriatric population. Int J Geriatr Psychiatry 2020; 35(12):1437–41.
13. 13- Boccia M, Aronne L, Celia B et al. COVID-19 and coagulative axis: Review of emerging aspects in a novel disease. Monaldi. Arch. Chest. Dis 2020; 90(2).
14. 14- Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: Bleeding and thrombotic manifestations of SARS-CoV2 Infection. Blood 2020; 136(4):489–500.
15. 15- Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135 (23):2033–40.
16. 16- Kowalewski M, Fina D, Słomka A et al. COVID-19 and ECMO: The interplay between coagulation and inflammation—a narrative review. Crit. Care 2020;24 (1):205.
17. 17- 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. Lancet 2020; 395(10229): 1054–62.
18. 18- 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; 18:844–7.
19. 19- Martín Rojas RM, Pérez Rus G, Delgado Pinos VE, et al. COVID-19 coagulopathy: an-in depth analysis of the coagulation system. Eur J Haematol 2020;105 (6):741–50.
20. 20- Mikami T, Miyashita H, Yamada T, et al. Risk factors for mortality in patients with COVID-19 in New York City. J Gen Intern Med 2021;36 (1):17–26.
21. 21- Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020;395 (10239):1763–70.
22. 22- Zhou S, Zhu T, Wang Y, Xia L. Imaging features and evolution on CT in 100 COVID-19 pneumonia patients in Wuhan, China. Eur Radiol 2020:1–9.
23. 23-Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382 (18):1708–20.
24. 24- Snijders D, Schoorl M, Schoorl M, Bartels PC, Van Der Werf TS, Boersma WG. D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial. Eur J Intern Med 2012;23(5):436–41.
25. 25-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.
26. 26- 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.
27. 27- Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11):1061–9.
28. 28- Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 80(7):934–43.
29. 29- 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.
30. 30- Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020;120 (5):876–8.
31. 31- Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J Thromb Haemost 2020; 4:786–7.
32. 32- Guan W-J, Liang W-H, Y. Zhao, Liang H-R, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: a nationwide analysis, Eur. Respir. J 2020; 55(5):2000547.