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Meta-Analysis
. 2021 Jan-Dec:27:1076029620987629.
doi: 10.1177/1076029620987629.

Systemic Coagulopathy in Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Noppacharn Uaprasert  1   2 , Chatphatai Moonla  2   3 , Darintr Sosothikul  4 , Ponlapat Rojnuckarin  1   2 , Thita Chiasakul  1   2
Affiliations
Meta-Analysis

Systemic Coagulopathy in Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Noppacharn Uaprasert et al. Clin Appl Thromb Hemost. 2021 Jan-Dec.

Abstract

Coagulation activation has been reported in several cohorts of patients Coronavirus Disease 2019 (COVID-19). However, the true burden of systemic coagulopathy in COVID-19 remains unknown. In this systematic review and meta-analysis, we performed a literature search using PubMed, EMBASE, and Cochrane Database to identify studies that reported the prevalence of systemic coagulopathy using established criteria in patients with COVID-19. The primary outcome was the prevalence of systemic coagulopathy (disseminated intravascular coagulation [DIC] and/or sepsis-induced coagulopathy [SIC]). Pooled prevalences and 95% confidence intervals [CIs] were calculated using random-effects model. A total of 5 studies including 1210 patients with confirmed COVID-19 were included. The pooled prevalence of systemic coagulopathy was 7.1% (95%CI: 3.2%,15.3%, I2 = 93%). The pooled prevalence of DIC (N = 721) and SIC (N = 639) were 4.3% (95%CI 1.7%, 10.4%, I2 = 84%) and 16.2% (95%CI: 9.3%, 26.8%, I2 = 74%), respectively. Only 2 studies reported the prevalence of elevated D-dimer levels with the pooled prevalence of 84.6% (95%CI: 52.0%,96.5%, I2 = 94%). Average D-dimer and fibrinogen levels were remarkably increased, while platelet counts, PT, and aPTT ratios were minimally affected in COVID-19. The estimated prevalence of systemic coagulopathy in patients with COVID-19 was low despite D-dimer elevation in most patients. Relatively low systemic coagulopathy in COVID-19 may contribute to the high incidence of thrombosis rather than bleeding in patients with COVID-19.

Keywords: COVID-19; disseminated intravascular coagulation; meta-analysis; sepsis-induced coagulopathy; systemic coagulopathy.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Forest plot showing pooled estimated prevalence of systemic coagulopathy in COVID-19.
Figure 3.
Figure 3.
Forest plots showing pooled estimated prevalence of disseminated intravascular coagulation in COVID-19.
Figure 4.
Figure 4.
Forest plot showing pooled estimated prevalence of sepsis-induced coagulopathy in COVID-19.
Figure 5.
Figure 5.
Forest plot showing pooled estimated prevalence of D-dimer elevation in COVID-19.
See this image and copyright information in PMC

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