SARS-CoV-2 induced-coagulopathy and prognosis in hospitalized patients

Background It has been reported altered coagulation in a significant proportion of patients hospitalized for SarsCov2 infection We analyzed coagulation parameters[PT, aPTT, D-dimer(DD), platelet count (Plt)] at hospital admission of a consecutive series of patients with documented infection hospitalized in Careggi Hospital Methods 209 consecutive patients(133M) with confirmed SarsCov2,admitted to Hospital were enrolled The clinical outcomes were monitored: median follow-up 11 days Results 31 patients died(14 8%) and 117 patients had been discharged(56%) 51 patients(24 4%) have been transferred to ICU 8 thrombotic events were documented (3 8%) Dead patients were older and, at admission, they had significantly higher PT-INR, PT sec, and MPV with respect to survivors No differences were detected in aPTTratio and Plt In 60 subgroup patients, non-survivors showed higher reticulated platelets[n=8, 7 7%(6 9-10 9%)] with respect to survivors[n= 52, 5 5%(3 3-9 2%)] ROC curves revealed that the cut-offs with the highest sensitivity and specificity for the end-point death were: 1 40 for PT-INR;1000ng/ml for DD and 11 9fL for MPV By defining "SarsCov2 inducedcoagulopathy" as a combination of the 3 parameters (the presence of a value EQUAL or HIGHER than the reported cut-off for more than one parameter),AUC increased to 0 78±0 06(p<0 05) The addition of the "SarsCov2 inducedcoagulopathy", to a model that included age, which is per se a strong predictor of death (AUC 0 89±0 04), slightly increased the AUC(0 92±0 03;p=0 10) for detection of death At multivariate regression analysis, adjusted for age and sex, age and SarsCov2induced coagulopathy were independent predictors of death (age: OR=1 17,95%CI1 07-1 27;p<0 0001/SarsCov2 induced coagulopathy: OR=2 72,95%CI1 20-6 17;p=0 016) Discharged patients were younger and had significantly lower PT-INR, PT sec, DD and MPV values No differences were detected in aPTT ratio and Plt ROC curves revealed that the cut-offs with the highest sensitivity and specificity for the end-point discharge were: 1 23 for PT-INR;1000 ng/ml for DD and 10 6 fL for MPV By defining "NO SarsCov2 induced-coagulopathy" as a combination of the 3 parameters (the presence of a value LOWER than the reported cut-off for more than one parameter),AUC increased to 0 79±0 04(p<0 05) By adding "NO SarsCOv2 induced-coagulopathy" to a model including age(AUC 0 80± 0 04), significantly increased the AUC (0 88±0 03;p=0 016) for discharge Conclusions The absence, at hospital admission, of an involvement in clotting and fibrinolytic pathways identifies patients at low risk of complications These data suggest a possible clinical utility of a score based on routine coagulation parameters in order to stratify the prognosis of hospitalized patients with SarsCov2 infection