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Article

Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions

1
Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
2
Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
3
Department of Molecular Medicine and Medical Biotechnologies, Federico II University, 80131 Naples, Italy
4
Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
5
Unipol Group, 40128 Bologna, Italy
6
Department of Pharmacy, Federico II University, 80131 Naples, Italy
*
Author to whom correspondence should be addressed.
The two Authors share co-seniorship.
J. Clin. Med. 2020, 9(7), 2244; https://doi.org/10.3390/jcm9072244
Received: 20 May 2020 / Revised: 30 June 2020 / Accepted: 10 July 2020 / Published: 15 July 2020
(This article belongs to the Section Cardiology)
Background: Complications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters. Methods: Data on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated. Results: Sixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: −0.74; 95%CI: −1.01, −0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: −0.60, 95%CI: −0.82, −0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen. Conclusions: Significant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients. View Full-Text
Keywords: SARS-CoV-2; COVID-19; hemostasis; thrombosis; coagulation; disability; outcome SARS-CoV-2; COVID-19; hemostasis; thrombosis; coagulation; disability; outcome
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MDPI and ACS Style

Di Minno, M.N.D.; Calcaterra, I.; Lupoli, R.; Storino, A.; Spedicato, G.A.; Maniscalco, M.; Di Minno, A.; Ambrosino, P. Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions. J. Clin. Med. 2020, 9, 2244. https://doi.org/10.3390/jcm9072244

AMA Style

Di Minno MND, Calcaterra I, Lupoli R, Storino A, Spedicato GA, Maniscalco M, Di Minno A, Ambrosino P. Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions. Journal of Clinical Medicine. 2020; 9(7):2244. https://doi.org/10.3390/jcm9072244

Chicago/Turabian Style

Di Minno, Matteo N.D., Ilenia Calcaterra, Roberta Lupoli, Antonio Storino, Giorgio A. Spedicato, Mauro Maniscalco, Alessandro Di Minno, and Pasquale Ambrosino. 2020. "Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions" Journal of Clinical Medicine 9, no. 7: 2244. https://doi.org/10.3390/jcm9072244

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