Severe COVID-19 and coagulopathy: A systematic review and meta-analysis

INTRODUCTION: Coronavirus disease 2019 (COVID-19)-induced coagulopathy (CIC) has been widely reported in the literature However, the spectrum of abnormalities associated with CIC has been highly variable METHODS: We conducted a systematic review of the literature (until 1 June 2020) to assess CIC and disease severity during the early COVID-19 pandemic Primary outcomes were pooled mean differences in platelet count, D-dimer level, prothrombin time, activated partial thromboplastin time (aPTT) and fibrinogen level between non-severe and severe patients, stratified by degree of hypoxaemia or those who died The risk factors for CIC were analysed Random-effects meta-analyses and meta-regression were performed using R version 3 6 1, and certainty of evidence was rated using the Grading of Recommendation, Assessment, Development, and Evaluation approach RESULTS: Of the included 5,243 adult COVID-19 patients, patients with severe COVID-19 had a significantly lower platelet count, and higher D-dimer level, prothrombin time and fibrinogen level than non-severe patients Pooled mean differences in platelet count (-19 7×109/L, 95% confidence interval [CI] -31 7 to -7 6), D-dimer level (0 8μg/mL, 95% CI 0 5-1 1), prothrombin time (0 4 second, 95% CI 0 2-0 6) and fibrinogen level (0 6g/L, 95% CI 0 3-0 8) were significant between the groups Platelet count and D-dimer level were significant predictors of disease severity on meta-regression analysis Older men had higher risks of severe coagulopathic disease CONCLUSION: Significant variability in CIC exists between non-severe and severe patients, with platelet count and D-dimer level correlating with disease severity Routine monitoring of all coagulation parameters may help to assess CIC and decide on the appropriate management