TY - JOUR
T1 - Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York
T2 - Observational Cohort
AU - Reyes Gil, Morayma
AU - Gonzalez-Lugo, Jesus D.
AU - Rahman, Shafia
AU - Barouqa, Mohammad
AU - Szymanski, James
AU - Ikemura, Kenji
AU - Lo, Yungtai
AU - Billett, Henny H.
N1 - Funding Information:
We greatly appreciate the efforts of our fellow health care workers and support staff at the Montefiore Medical Center for providing outstanding patient care at considerable personal risk on the front lines of this pandemic. We express our support for our patients with Covid-19 and their families. We also thank Dr. Eran Bellin, MD (Vice President Clinical IT Research and Development Montefiore Information Technology Professor of Clinical Epidemiology and Population Health Albert Einstein College of Medicine) and Lindsay Stahl for providing guidance about study design and interpretation of results. This manuscript has been released as a pre-print at MedRXiv (Lamb et al., 2020).
Publisher Copyright:
© Copyright © 2021 Reyes Gil, Gonzalez-Lugo, Rahman, Barouqa, Szymanski, Ikemura, Lo and Billett.
PY - 2021/2/23
Y1 - 2021/2/23
N2 - Importance: COVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020. Objective: To investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death. Design: Retrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020. Setting: Montefiore Health System main hospital, Moses, a large tertiary care center in the Bronx. Participants: Adult inpatients with positive COVID tests hospitalized at MHS. Exposure (for observational studies): Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data. Main Outcome and Measures: Relationship and predictive value of measured parameters to mortality and illness severity. Results: Of the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged). Conclusion: We describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.
AB - Importance: COVID-19 has caused a worldwide illness and New York became the epicenter of COVID-19 in the United States from Mid-March to May 2020. Objective: To investigate the coagulopathic presentation of COVID and its natural course during the early stages of the COVID-19 surge in New York. To investigate whether hematologic and coagulation parameters can be used to assess illness severity and death. Design: Retrospective case study of positive COVID inpatients between March 20, 2020-March 31, 2020. Setting: Montefiore Health System main hospital, Moses, a large tertiary care center in the Bronx. Participants: Adult inpatients with positive COVID tests hospitalized at MHS. Exposure (for observational studies): Datasets of participants were queried for demographic (age, sex, socioeconomic status, and self-reported race and/or ethnicity), clinical and laboratory data. Main Outcome and Measures: Relationship and predictive value of measured parameters to mortality and illness severity. Results: Of the 225 in this case review, 75 died during hospitalization while 150 were discharged home. Only the admission PT, absolute neutrophil count (ANC) and first D-Dimer could significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 2.1 μg/mL. 15% of discharged patients required readmission and more than a third of readmitted patients died (5% of all initially discharged). Conclusion: We describe here a comprehensive assessment of hematologic and coagulation parameters in COVID-19 and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments. Furthermore, D-Dimer may be useful to follow up discharged patients.
KW - COVID-19
KW - D-Dimer
KW - New York City
KW - coagulopathy
KW - prothrombin time
UR - http://www.scopus.com/inward/record.url?scp=85102360874&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85102360874&partnerID=8YFLogxK
U2 - 10.3389/fphys.2021.618929
DO - 10.3389/fphys.2021.618929
M3 - Article
AN - SCOPUS:85102360874
SN - 1664-042X
VL - 12
JO - Frontiers in Physiology
JF - Frontiers in Physiology
M1 - 618929
ER -