(4) Critical cases met any of the following: respiratory failure occurs, and mechanical ventilation is required shock occurs or complicated with other organ failure that requires monitoring and treatment in ICU. Patients with >50% lesion progression within 24 to 48 hours in pulmonary imaging were treated as severe cases. (3) Severe cases met any of the following: respiratory distress, breaths/min the oxygen saturation is less than 93% at a rest state or arterial partial pressure of ( ). (2) Ordinary cases had symptoms like fever and respiratory tract symptoms, and pneumonia manifestation can be seen in imaging. (1) Mild cases had mild clinical symptoms and no pneumonia manifestation in imaging. Case IdentificationĪccording to the Guidance for Corona Virus Disease 2019: Prevention, Control, Diagnosis, and Management edited by the National Health Commission of the People’s Republic of China, all cases were identified into four categories of mild cases, ordinary cases, severe cases, and critical cases. This study was approved by the Medical Ethics Review Board of Wuhan University of Science and Technology (No. Cases with incomplete laboratory data or with a duration of hospitalization shorter than 14 days prior to March 5, 2020, were excluded. Cases of hospital discharge, death, and under treatment with a duration of hospitalization longer than 14 days prior to March 5, 2020, were studied. Three clinical disease assessments were conducted using laboratory data collected. The confirmed patients had a positive result of the nucleic acid test of SARS-CoV-2 by real-time fluorescence RT-PCR. The information of a total of 115 patients with confirmed COVID-19 who were admitted to Tianyou Hospital affiliated to the Wuhan University of Science and Technology between January 18, 2020, and March 5, 2020, was collected. Source of Patients and Diagnosis Criteria The aim of the report is to investigate role of the dynamic changes of DD, PT, APTT, TT, and Fg in predicting the severity and prognosis in patients with COVID-19. Commonly used clinical laboratory coagulation indexes, such as D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fg), could sensitively reflect the clotting state of the body. Therefore, early identification of the severity is very important to the clinical diagnosis of and treatment for COVID-19. Most of the patients have a favorable prognosis, but some rapidly progress to severe and critical cases with respiratory distress syndrome, coagulation dysfunction, multiple organ failure, etc. The main clinical manifestation is lung injury. It is typically spread via respiratory droplets and during close contact. IntroductionĬOVID-19 which emerged in Wuhan, Hubei Province, China, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). DD and PT could be used as the significant indicators in predicting the mortality of COVID-19. Coagulation dysfunction is more likely to occur in severe and critically ill patients. In addition, with the progression of the disease, the change of CT imaging was closely related to the increase of the DD value ( ). The results from ROC analyses for mortality risk showed that the AUCs of DD were 0.742, 0.818, and 0.851 in three times of test, respectively PT was 0.643, 0.824, and 0.937.
Among 23 patients who deceased, 18 had DD increased at the first lab test, 22 had DD increased at the second and third lab tests, and 18 had prolonged PT at the third test. The levels of DD and Fg were correlated with clinical classification. Coagulation disorder occurred at the early stage of COVID-19 infection, with 50 (43.5%) patients having DD increased and 74 (64.3%) patients having Fg increased. The dynamic changes of DD, PT, APTT, and Fg were tested, and the correlation with CT imaging, clinical classifications, and prognosis was studied. A total of 115 patients with confirmed COVID-19, who were admitted to Tianyou Hospital of Wuhan University of Science and Technology between January 18, 2020, and March 5, 2020, were included. To investigate the value of coagulation indicators D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fg) in predicting the severity and prognosis of COVID-19.
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