Coagulation dysfunction in ICU patients with coronavirus disease 2019 in Wuhan, China: a retrospective observational study of 75 fatal cases.
Coagulation dysfunction in ICU patients with coronavirus disease 2019 in Wuhan, China: a retrospective observational study of 75 fatal cases.
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DOI：
10.18632/aging.202223
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发表时间：
2020-12-09
期刊：
影响因子：
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通讯作者：
Zheng X
中科院分区：
文献类型：
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作者：
Shi J;Zhang W;Sang L;Qu Z;Zhong M;Jiang L;Song B;Kang L;Zhang Y;Wang X;Zhang D;Zheng X
2019冠状病毒病（COVID-19）重症患者的凝血功能障碍尚未得到很好的描述，抗凝治疗的疗效尚不清楚。在这项研究中，我们回顾性分析了75例在金银潭医院（中国武汉）重症监护室收治的致命COVID-19病例。病例的中位年龄为67（62-74）岁，47（62.7%）例为男性。50例患者（66.7%）被诊断为弥散性血管内凝血。约90%的患者D-二聚体和纤维蛋白原降解产物升高，抗凝治疗后持续下降，并伴有白蛋白升高（均P<0.05）。抗凝治疗组的中位生存期为9.0（6.0-14.0）d，而未抗凝治疗组为7.0（3.0-10.0）d（P=0.008）。抗凝治疗后，C反应蛋白水平降低（P=0.004），高敏肌钙蛋白（P=0.018）、乳酸脱氢酶（P<0.001）和羟丁酸脱氢酶（P<0.001）也降低。总之，凝血障碍在致命的COVID-19病例中普遍存在。抗凝治疗部分改善了高凝状态，延长了中位生存时间，并可能推迟了炎症过程和心脏损伤。
Coagulation dysfunction in critically ill patients with coronavirus disease 2019 (COVID-19) has not been well described, and the efficacy of anticoagulant therapy is unclear. In this study, we retrospectively reviewed 75 fatal COVID-19 cases who were admitted to the intensive care unit at Jinyintan Hospital (Wuhan, China). The median age of the cases was 67 (62–74) years, and 47 (62.7%) were male. Fifty patients (66.7%) were diagnosed with disseminated intra-vascular coagulation. Approximately 90% of patients had elevated D-dimer and fibrinogen degradation products, which decreased continuously after anticoagulant treatment and was accompanied by elevated albumin (all P<0.05). The median survival time of patients treated with anticoagulant was 9.0 (6.0–14.0) days compared with 7.0 (3.0–10.0) days in patients without anticoagulant therapy (P=0.008). After anticoagulation treatment, C-reactive protein levels decreased (P=0.004), as did high-sensitivity troponin (P=0.018), lactate dehydrogenase (P<0.001), and hydroxybutyrate dehydrogenase (P<0.001). In conclusion, coagulation disorders were widespread among fatal COVID-19 cases. Anticoagulant treatment partially improved hypercoagulability, prolonged median survival time, and may have postponed inflammatory processes and cardiac injury.