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. 2020 Jun 8;9(6):1781.
doi: 10.3390/jcm9061781.

Non-Overt Coagulopathy in Non-ICU Patients with Mild to Moderate COVID-19 Pneumonia

Daniela Mazzaccaro  1 , Francesca Giacomazzi  2 , Matteo Giannetta  1 , Alberto Varriale  1 , Rosa Scaramuzzo  3 , Alfredo Modafferi  1 , Giovanni Malacrida  1 , Paolo Righini  1 , Massimiliano M Marrocco-Trischitta  1 , Giovanni Nano  1   4
Affiliations

Non-Overt Coagulopathy in Non-ICU Patients with Mild to Moderate COVID-19 Pneumonia

Daniela Mazzaccaro et al. J Clin Med. .

Abstract

Introduction: Aim of the study is to assess the occurrence of early stage coagulopathy and disseminated intravascular coagulation (DIC) in patients with mild to moderate respiratory distress secondary to SARS-CoV-2 infection.

Materials and methods: Data of patients hospitalized from 18 March 2020 to 20 April 2020 were retrospectively reviewed. Two scores for the screening of coagulopathy (SIC and non-overt DIC scores) were calculated. The occurrence of thrombotic complication, death, and worsening respiratory function requiring non-invasive ventilation (NIV) or admission to ICU were recorded, and these outcomes were correlated with the results of each score. Chi-square test, receiver-operating characteristic curve, and logistic regression analysis were used as appropriate. p Values < 0.05 were considered statistically significant.

Results: Data of 32 patients were analyzed. Overt-DIC was diagnosed in two patients (6.2%), while 26 (81.2%) met the criteria for non-overt DIC. Non-overt DIC score values ≥4 significantly correlated with the need of NIV/ICU (p = 0.02) and with the occurrence of thrombotic complications (p = 0.04). A score ≥4 was the optimal cut-off value, performing better than SIC score (p = 0.0018). Values ≥4 in patients with thrombotic complications were predictive of death (p = 0.03).

Conclusions: Overt DIC occurred in 6.2% of non-ICU patients hospitalized for a mild to moderate COVID-19 respiratory distress, while 81.2% fulfilled the criteria for non-overt DIC. The non-overt DIC score performed better than the SIC score in predicting the need of NIV/ICU and the occurrence of thrombotic complications, as well as in predicting mortality in patients with thrombotic complications, with a score ≥4 being detected as the optimal cut-off.

Keywords: COVID-19; DIC; disseminated intravascular coagulation; respiratory distress.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The screening of coagulopathy (SIC) and the non-overt disseminated intravascular coagulation (DIC) scoring systems.
Figure 2
Figure 2
Algorithm that was used in our case series for the screening of overt and non-overt DIC, according to the recommendation of the International Society of Hemostasis and Thrombosis (ISTH).
Figure 3
Figure 3
Receiver operating characteristic (ROC) analysis of the SIC score (curve with circles) and the non-overt DIC score (curve with the triangles) in predicting respiratory function requiring NIV/ICU. Area under curve is reported for both.
See this image and copyright information in PMC

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