Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis

doi:10.1016/j.thromres.2021.02.010

Meta-Analysis

. 2021 May:201:23-29.

doi: 10.1016/j.thromres.2021.02.010. Epub 2021 Feb 17.

Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis

Xianghui Zhou¹, Zhipeng Cheng¹, Lili Luo¹, Ying Zhu², Wenyi Lin¹, Zhangyin Ming³, Wei Chen⁴, Yu Hu⁵

Affiliations

¹ Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China.
² Department of Pharmacology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China.
³ Department of Pharmacology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China; Tongji-Rongcheng Center for Biomedicine, Huazhong University of Science and Technology, Wuhan 430022, China.
⁴ Laboratory of Vaccine and Antibody Engineering, Beijing Institute of Biotechnology, Beijing 100071, China. Electronic address: cw0226@foxmail.com.
⁵ Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China; Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, Hubei 430022, China. Electronic address: dr_huyu@126.com.

PMID: 33631519
PMCID: PMC7886625
DOI: 10.1016/j.thromres.2021.02.010

Meta-Analysis

Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis

Xianghui Zhou et al. Thromb Res. 2021 May.

. 2021 May:201:23-29.

doi: 10.1016/j.thromres.2021.02.010. Epub 2021 Feb 17.

Authors

Xianghui Zhou¹, Zhipeng Cheng¹, Lili Luo¹, Ying Zhu², Wenyi Lin¹, Zhangyin Ming³, Wei Chen⁴, Yu Hu⁵

Affiliations

¹ Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China.
² Department of Pharmacology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China.
³ Department of Pharmacology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China; Tongji-Rongcheng Center for Biomedicine, Huazhong University of Science and Technology, Wuhan 430022, China.
⁴ Laboratory of Vaccine and Antibody Engineering, Beijing Institute of Biotechnology, Beijing 100071, China. Electronic address: cw0226@foxmail.com.
⁵ Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China; Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, Hubei 430022, China. Electronic address: dr_huyu@126.com.

PMID: 33631519
PMCID: PMC7886625
DOI: 10.1016/j.thromres.2021.02.010

Abstract

Objectives: Coronavirus disease 2019 (COVID-19) is a novel infectious disease, with significant morbidity and mortality. This meta-analysis is to evaluate the prevalence of disseminated intravascular coagulation (DIC) in COVID-19 patients and to determine the association of DIC with the severity and prognosis of COVID-19.

Methods: We searched the PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) database until August 12, 2020. The meta-analysis was performed using Stata 16.0 software.

Results: 14 studies were included in our meta-analysis. The pooled analysis revealed that the incidence of COVID-19 patients developing DIC was 3% (95%: 1%-5%, P < 0.001). In addition, deaths were more likely to be associated with DIC (Log OR = 2.46, 95% CI: 0.94-3.99, P < 0.001) with statistical significance.

Conclusions: DIC is associated with the severity and poor prognosis of COVID-19 patients. Therefore, attention should be paid to coagulation dysfunction in COVID-19 patients. Monitoring of coagulation indicators may improve the prognosis of COVID-19 inpatients.

Keywords: Coronavirus disease 2019 (COVID-19); Disseminated intravascular coagulation; SARS-CoV-2.

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Conflict of interest statement

The author reports no conflicts of interest in this work.

Figures

**Fig. 1**
Flow diagram of the literature search and selection process in the meta-analysis.

**Fig. 2**
Forest plot of incidence of DIC.

**Fig. 3**
The Log risk ratio of DIC in survivors compared with deaths and severepatients compared with Non-severe patients.

**Fig. 4**
Results of publication bias after trim and fill method.

**The following is the supplementary data related to this article.Supplementary Fig. 1**
The subgroup analysis of incidence ofDIC,A: ISTH criteria; B:non-ISTH criteria.

See this image and copyright information in PMC

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[1] Wang C., Horby P.W., Hayden F.G., Gao G.F. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470–473. - PMC - PubMed

[2] Wang C., Horby P.W., Hayden F.G., Gao G.F. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470–473. - PMC - PubMed

[3] Lu R., Zhao X., Li J., Niu P., Yang B., Wu H., Wang W., Song H., Huang B., Zhu N., Bi Y., Ma X., Zhan F., Wang L., Hu T., Zhou H., Hu Z., Zhou W., Zhao L., Chen J., Meng Y., Wang J., Lin Y., Yuan J., Xie Z., Ma J., Liu W.J., Wang D., Xu W., Holmes E.C., Gao G.F., Wu G., Chen W., Shi W., Tan W. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. - PMC - PubMed

[4] Lu R., Zhao X., Li J., Niu P., Yang B., Wu H., Wang W., Song H., Huang B., Zhu N., Bi Y., Ma X., Zhan F., Wang L., Hu T., Zhou H., Hu Z., Zhou W., Zhao L., Chen J., Meng Y., Wang J., Lin Y., Yuan J., Xie Z., Ma J., Liu W.J., Wang D., Xu W., Holmes E.C., Gao G.F., Wu G., Chen W., Shi W., Tan W. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. - PMC - PubMed

[5] Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., Niu P., Zhan F., Ma X., Wang D., Xu W., Wu G., Gao G.F., Tan W. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020;382(8):727–733. - PMC - PubMed

[6] Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., Niu P., Zhan F., Ma X., Wang D., Xu W., Wu G., Gao G.F., Tan W. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020;382(8):727–733. - PMC - PubMed

[7] Barnes G.D., Burnett A., Allen A., Blumenstein M., Clark N.P., Cuker A., Dager W.E., Deitelzweig S.B., Ellsworth S., Garcia D., Kaatz S., Minichiello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J. Thromb. Thrombolysis. 2020;50(1):72–81. - PMC - PubMed

[8] Barnes G.D., Burnett A., Allen A., Blumenstein M., Clark N.P., Cuker A., Dager W.E., Deitelzweig S.B., Ellsworth S., Garcia D., Kaatz S., Minichiello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J. Thromb. Thrombolysis. 2020;50(1):72–81. - PMC - PubMed

[9] Wong R.S., Wu A., K.F. To, Lee N., Lam C.W., Wong C.K., Chan P.K., Ng M.H., Yu L.M., Hui D.S., Tam J.S., Cheng G., Sung J.J. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. Bmj. 2003;326(7403):1358–1362. - PMC - PubMed

[10] Wong R.S., Wu A., K.F. To, Lee N., Lam C.W., Wong C.K., Chan P.K., Ng M.H., Yu L.M., Hui D.S., Tam J.S., Cheng G., Sung J.J. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. Bmj. 2003;326(7403):1358–1362. - PMC - PubMed

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Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis

Affiliations

Incidence and impact of disseminated intravascular coagulation in COVID-19 a systematic review and meta-analysis

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