Coagulopathy indicates poor patient prognosis In COVID-19 patients: a guide to best practice
Stage UK has compiled a laboratory best practice guide to the management of COVID 19. It highlights studies showing how abnormal coagulation parameters such as D-dimer and the disseminated intravascular coagulation (DIC) score can indicate poor patient outcomes. One study shows that 71% of non-survivors had coagulopathy, compared with only 0.6% of survivors.
The DIC score, determined by the International Society on Thrombosis and Haemostasis (ISTH), appears to have a significant role in the clinical assessment of patients hospitalised with proven COVID-19 infection. See more in your free copy of Stago’s COVID-19 digest of publications and recommendation (https://mailchi.mp/c353cb257a90/covid).
Coagulopathy can arise from the body’s inflammatory response to the viral infection and may lead to tissue damage and death. Data published by haematologists from Wuhan indicate that identifying abnormal parameters can be a useful predictor of death following pneumonia. Another study comments on the marked difference in ‘frequency between survivors and non-survivors compared with other diseases associated with DIC’, as shown in the Table.
The DIC score is calculated by measuring the platelet count, D-dimer, fibrinogen and prothrombin time. Evidence shows that when a coagulation screen is requested in an affected patient, D-dimer and fibrinogen should be automatically added to the prothrombin time. Furthermore, adding a comment giving the DIC score may also help clinicians manage the patient.
Another study from China shows the trend towards fatality is significantly higher in older patients admitted to hospital with D-dimer levels >1.0 μg/mL and a high Sequential Organ Failure Assessment (SOFA) score. Also, the median duration of viral shedding was 20 days in survivors, but this continued up to death in fatal cases.
Data from China show that patients with a high sepsis‐induced coagulopathy (SIC) score or markedly elevated D-dimer appear to be significantly more at risk in this pandemic. However, evidence has already come to light that anticoagulant treatment, primarily with low molecular weight heparin (LMWH), was associated with decreased mortality in severe coronavirus patients presenting with a high SIC score.
“The laboratory has a significant role to play in the management of COVID-19. It appears from these clinical findings that, if the abnormal parameters are present on admission, they seem to indicate that early intervention and more proactive treatment would be needed to avert a poor outcome,” explained Stago marketing manager Gill Eyre.