Padua Score and Coagulopathy Parameters on Survival of COVID-19 Patients at Prof Dr. R. D. Kandou General Hospital Manado
DOI:
https://doi.org/10.3889/oamjms.2023.11583Keywords:
COVID-19, Padua Score, Coagulopathy, SurvivalAbstract
BACKGROUND: Coagulopathy in coronavirus disease 2019 (COVID-19) patients causes a prothrombotic state that increases the risk of thromboembolism. The Padua score and coagulopathy parameter including D-dimer values, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts are very important parameters to determine risk of thrombosis and mortality in hospitalized COVID-19 patients.
AIM: This study aimed to assess the prognosis of COVID-19 patients with Padua score and coagulopathy parameters.
METHODS: This retrospective cohort study was conducted in tertiary university hospital, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia from October 2020 to July 2021. Patients admitted with final diagnosis of COVID-19 confirmed with positive reverse transcriptase-polymer chain reaction test were included in the study. The data were refined by excluding the patients under 18 years old and the patients with no blood test results, D-dimer values, fibrinogen values, PT values, aPTT values, and platelet counts. The association of Padua score and coagulopathy parameters with survival of COVID-19 patients was analyzed by multivariate cox regression and Kaplan–Meier analysis.
RESULTS: The probability of survival on day 14 in patients with Padua score <4, D-dimer <0.5 mg/dl, PT ≤16 s, aPTT ≤39 s, and platelets >150,000/μL was 100%, 100%, 84.6%, 81.5%, and 81.4%, respectively. COVID-19 survival was influenced by Padua score ≥4 (heart rate [HR] = 4.199; CI 95% 2.221–7.936), D-dimer ≥0.5 mg/L (HR = 4.772; CI 95% 2.244–10.147), PT >16 s (HR = 2.124; CI 95% 1.608–2.805), aPTT >39 s (HR = 1.449; CI 95% 1.080–1.943), and platelet count <150000/μL (HR = 2.056; CI 95% 1.489–2.840). Padua score has the highest probability of mortality compared to the other coagulopathy parameters (p < 0.001; HR = 3.655; CI 95% 1.927–6.932).
CONCLUSION: There was an association of Padua score, D-dimer value, PT value, aPTT value, and platelet count on survival of COVID-19 patients. Padua score being the most influential variable on survivals.
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Health Ministry of the Republic of Indonesia. Guidelines for the Prevention and Control of Coronavirus Disease (COVID-19). 5th Revisi. Jakarta: Health Ministry of the Republic of Indonesia; 2020. Available from: https://infeksiemerging. kemkes.go.id/download/REV-05_Pedoman_P2_COVID-19_13_Juli_2020_1.pdf [Last accessed on 2020 Nov 20].
Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-40. https://doi.org/10.1016/S2352-3026(20)30145-9 PMid: 32407672 DOI: https://doi.org/10.1016/S2352-3026(20)30145-9
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-40. https://doi.org/10.1182/blood.2020006000 PMid: 32339221 DOI: https://doi.org/10.1182/blood.2020006000
Zhang A, Leng Y, Zhang Y, Wu K, Ji Y, Lei S, et al. Meta-analysis of coagulation parameters associated with disease severity and poor prognosis of COVID-19. Int J Infect Dis. 2020;100:441-8. https://doi.org/10.1016/j.ijid.2020.09.021 PMid: 32947052 DOI: https://doi.org/10.1016/j.ijid.2020.09.021
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3 PMid: 32171076 DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
Goshua G, Pine AB, Meizlish ML, Chang CH, Zhang H, Bahel P, et al. Endotheliopathy in COVID-19-associated coagulopathy: Evidence from a single-centre, cross-sectional study. Lancet Haematol. 2020;7(8):e575-82. https://doi.org/10.1016/S2352-3026(20)30216-7 PMid: 32619411 DOI: https://doi.org/10.1016/S2352-3026(20)30216-7
Klok FA, Kruip MJ, van der Meer NJ, Arbous MS, Gommers DA, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7. https://doi.org/10.1016/j.thromres.2020.04.013 PMid: 32291094 DOI: https://doi.org/10.1016/j.thromres.2020.04.013
Wang T, Chen R, Liu C, Liang W, Guan W, Tang R, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol. 2020;7(5):e362-3. https://doi.org/10.1016/S2352-3026(20)30109-5 PMid: 32278361 DOI: https://doi.org/10.1016/S2352-3026(20)30109-5
Salabei JK, Fishman TJ, Asnake ZT, Ali A, Iyer UG. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Hear Lung. 2021;50(2):357-60. https://doi.org/10.1016/j.hrtlng.2021.01.011 PMid: 33524866 DOI: https://doi.org/10.1016/j.hrtlng.2021.01.011
Short SA, Gupta S, Brenner SK, Hayek SS, Srivastava A, Shaefi S, et al. D-dimer and death in critically Ill patients with coronavirus disease 2019. Crit Care Med. 2021;49(5):e500-11. https://doi.org/10.1097/CCM.0000000000004917 PMid: 33591017 DOI: https://doi.org/10.1097/CCM.0000000000004917
Long W, Yang J, Li Z, Li J, Chen S, Chen D, et al. Abnormal fibrinogen level as a prognostic indicator in coronavirus disease patients: A retrospective cohort study. Front Med (Lausanne). 2021;8:687220. https://doi.org/10.3389/fmed.2021.687220 PMid: 34195213 DOI: https://doi.org/10.3389/fmed.2021.687220
Zong X, Gu Y, Yu H, Li Z, Wang Y. Thrombocytopenia is associated with covid-19 severity and outcome: An updated meta-analysis of 5637 patients with multiple outcomes. Lab Med. 2021;52(1):10-5. https://doi.org/10.1093/labmed/lmaa067 PMid: 32929506 DOI: https://doi.org/10.1093/labmed/lmaa067
Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19):Areview. JAMA. 2020;324(8):782-93. https://doi.org/10.1001/jama.2020.12839 PMid: 32648899 DOI: https://doi.org/10.1001/jama.2020.12839
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. https://doi.org/10.1111/jth.14768 PMid: 32073213 DOI: https://doi.org/10.1111/jth.14768
Nlandu Y, Mafuta D, Sakaji J, Brecknell M, Engole Y, Abatha J, et al. Predictors of mortality in COVID-19 patients at Kinshasa medical center and a survival analysis: A retrospective cohort study. BMC Infect Dis. 2021;21(1):1272. https://doi.org/10.1186/s12879-021-06984-x PMid: 34930174 DOI: https://doi.org/10.1186/s12879-021-06984-x
Wang D, Yin Y, Hu C, Liu X, Zhang X, Zhou S, et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care. 2020;24(1):188. https://doi.org/10.1186/s13054-020-02895-6 PMid: 32354360 DOI: https://doi.org/10.1186/s13054-020-02895-6
Abutaleb A, Nathan S. COVID-19 infection-associated coagulopathy: Pathophysiology and clinical implications. Interv Neuroradiol. 2021;27(1 suppl):6-12. https://doi.org/10.1177/15910199211035894 PMid: 34747644 DOI: https://doi.org/10.1177/15910199211035894
Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: The Padua prediction score. J Thromb Haemost. 2010;8(11):2450-7. https://doi.org/10.1111/j.1538-7836.2010.04044.x PMid: 20738765 DOI: https://doi.org/10.1111/j.1538-7836.2010.04044.x
Chen S, Zheng T, Wang S, Yu Y, Wang P, Song Y, et al. Association between risk of venous thromboembolism and mortality in patients with COVID-19. Int J Infect Dis. 2021;108:543-9. https://doi.org/10.1016/j.ijid.2021.06.005 PMid: 34107325 DOI: https://doi.org/10.1016/j.ijid.2021.06.005
Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. Am J Emerg Med. 2020;38(7):1544,e1-1544,e3. https://doi.org/10.1016/j.ajem.2020.04.011 PMid: 32312574 DOI: https://doi.org/10.1016/j.ajem.2020.04.011
Xie Y, Wang X, Yang P, Zhang S. Covid-19 complicated by acute pulmonary embolism. Radiol Cardiothorac Imaging. 2020;2(2):e200067. https://doi.org/10.1148/ryct.2020200067 PMid: 33778561 DOI: https://doi.org/10.1148/ryct.2020200067
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study. J Intensive Care. 2020;8:49. https://doi.org/10.1186/s40560-020-00466-z PMid: 32665858 DOI: https://doi.org/10.1186/s40560-020-00466-z
Wool GD, Miller JL. The impact of COVID-19 disease on platelets and coagulation. Pathobiology. 2021;88(1):15-27. https://doi.org/10.1159/000512007 PMid: 33049751 DOI: https://doi.org/10.1159/000512007
Poudel Y, Adhikari AI, Aryal BB, Dangol DI, Bajracharya TI, Maharjan A, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One. 2021;16(8):e0256744. https://doi.org/10.1371/journal.pone.0256744 PMid: 34437642 DOI: https://doi.org/10.1371/journal.pone.0256744
Soni M, Gopalakrishnan R, Vaishya R, Prabu P. D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases. Diabetes Metab Syndr Clin Res Rev. 2020;14(6):2245-9. https://doi.org/10.1016/j.dsx.2020.11.007 PMid: 33395786 DOI: https://doi.org/10.1016/j.dsx.2020.11.007
Han H, Yang L, Liu R, Liu F, Liu F, Wu KL, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20. https://doi.org/10.1515/cclm-2020-0188 PMid: 32172226 DOI: https://doi.org/10.1515/cclm-2020-0188
Bintoro SU, Dwijayanti NM, Pramudya D,Amrita PN, Romadhon PZ, Asmarawati TP, et al. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non-ICU ward: A single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res. 2021;10:791. https://doi.org/10.12688/f1000research.53803.3 PMid: 34904053 DOI: https://doi.org/10.12688/f1000research.53803.1
Long H, Nie L, Xiang X, Li H, Zhang X, Fu X, et al. D-Dimer and prothrombin time are the significant indicators of severe COVID-19 and poor prognosis. Biomed Res Int. 2020;2020:6159720. https://doi.org/10.1155/2020/6159720 PMid: 32596339 DOI: https://doi.org/10.1155/2020/6159720
Citu C, Burlea B, Gorun F. Predictive value of blood coagulation parameters in poor outcomes in COVID-19 patients: A retrospective observational study in Romania. J Clin Med. 2022;11(10):2831. https://doi.org/10.3390/jcm11102831 PMid: 35628956 DOI: https://doi.org/10.3390/jcm11102831
Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1469-72. https://doi.org/10.1111/jth.14848 PMid: 32302435 DOI: https://doi.org/10.1111/jth.14848
Zhu Y, Zhang J, Li Y, Liu F, Zhou Q, Peng Z. Association between thrombocytopenia and 180-day prognosis of COVID-19 patients in intensive care units: A two-center observational study. PLoS One. 2021;16(3):e0248671. https://doi.org/10.1371/journal.pone.0248671 PMid: 33735911 DOI: https://doi.org/10.1371/journal.pone.0248671
Mei H, Luo L, Hu Y. Thrombocytopenia and thrombosis in hospitalized patients with COVID-19. J Hematol Oncol. 2020;13(1):161. https://doi.org/10.1186/s13045-020-01003-z PMid: 33261634 DOI: https://doi.org/10.1186/s13045-020-01003-z
Hottz ED, Bozza FA, Bozza PT. Platelets in immune response to virus and immunopathology of viral infections. Front Med (Lausanne). 2018;5:121. https://doi.org/10.3389/fmed.2018.00121 PMid: 29761104 DOI: https://doi.org/10.3389/fmed.2018.00121
Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-8. https://doi.org/10.1007/s00277-020-04019-0 PMid: 32296910 DOI: https://doi.org/10.1007/s00277-020-04019-0
Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, et al. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020;31(4):490-6. https://doi.org/10.1080/09537104.2020.1754383 PMid: 32297540 DOI: https://doi.org/10.1080/09537104.2020.1754383
Zeng DX, Xu JL, Mao QX, Liu R, Zhang WY, Qian HY, et al. Association of Padua prediction score with in-hospital prognosis in COVID-19 patients. QJM. 2020;113(11):789-93. https://doi.org/10.1093/qjmed/hcaa224 PMid: 32652021 DOI: https://doi.org/10.1093/qjmed/hcaa224
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-9. https://doi.org/10.1001/jama.2020.6775 PMid: 32320003 DOI: https://doi.org/10.1001/jama.2020.6775
Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep vein thrombosis in hospitalized patients with COVID-19 in Wuhan, China: Prevalence, risk factors, and outcome. Circulation. 2020;142(2):114-28. https://doi.org/10.1161/CIRCULATIONAHA.120.046702 PMid: 32421381 DOI: https://doi.org/10.1161/CIR.0000000000000887
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Copyright (c) 2023 Linda Rotty, Cecilia Hendratta, Viky Damay, Harlinda Haroen, Pearla Lasut, Windy Wariki (Author)
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