Disseminated intravascular coagulation is associated with poor prognosis in patients with COVID-19

Abstract

This study aimed to investigate the incidence and significance of disseminated intravascular coagulation (DIC) in coronavirus disease 2019 (COVID-19). A multicenter cohort study was conducted using large-scale COVID-19 registry data. The patients were classified into DIC and non-DIC groups based on the diagnosis on admission (day 1) and on any of the days 1, 4, 8, and 15. In total, 23,054 patients were divided into DIC (n = 264) and non-DIC (n = 22,790) groups on admission. Thereafter, 1654 patients were divided into 181 patients with DIC and 1473 non-DIC patients based on the DIC diagnosis on any of the days from 1 to 15. DIC incidence was 1.1% on admission, increasing to 10.9% by day 15. DIC diagnosis on admission had moderate predictive performance for developing multiple organ dysfunction syndrome (MODS) on day 4 and in-hospital death and was independently associated with MODS and in-hospital death. DIC diagnosis on any of the days from 1 to 15, especially days 8 and 15, was associated with lower survival probability than those without DIC and showed significant association with in-hospital death. In conclusion, despite its low incidence, DIC, particularly late-onset DIC, plays a significant role in the pathogenesis of poor prognosis in patients with COVID-19.

Keywords: Coronavirus disease 2019 (COVID-19); Disseminated intravascular coagulation (DIC); Incidence; Organ dysfunction; Prognosis.

Figure 1

Flow chart of the inclusion and exclusion of the study.

Figure 2

Kaplan–Meier survival probability curves from enrollment to day 90. (A) patients diagnosed with DIC on admission; (B) patients diagnosed with DIC on any of days 1, 4, 8, and 15. Both (A) and (B) show significantly lower survival probability of patients with DIC than those without DIC. The numbers of graphs represent the number of DIC and non-DIC patients at risk of death on the indicated days. DIC, disseminated intravascular coagulation.

Figure 3

Kaplan–Meier survival probability curves from enrollment to day 90 of patients diagnosed with DIC on any of the days 1, 4, 8, and 15 and non-DIC patients. Significant differences in the survival probabilities of patients were found. Survival probabilities of patients diagnosed with DIC on day 8 were significantly lower than non-DIC patients (p < 0.001) and DIC patients diagnosed on day 4 (p < 0.0351). Additionally, significant differences in survival probabilities between day 15 and non-DIC (p < 0.001), day 15 and day 1 (p < 0.001), day 15 and day 4 (p < 0.001), and day 15 and day 8 (p < 0.0027) were observed. These suggest a lower survival probability in late-onset DIC than in early-onset DIC. The numbers of the graphs represent the number of DIC each day and non-DIC patients at risk of death on the indicated days. DIC, disseminated intravascular coagulation.

Figure 4

Predictive performance of DIC diagnosed on admission for developing MODS on day 4 (A) and in-hospital death (B). The ROC curve analyses showed moderate but significant predictive performance of DIC diagnosis for MODS (sensitivity 48.9 and specificity 75.2%) and in-hospital death (sensitivity 50.9% and specificity 79.6%). AUC, area under ROC curve; MODS, multiple organ dysfunction syndrome; ROC, receiver operating characteristic.