Coagulopathy in patients with Coronavirus Disease 2019 (COVID-19): A systematic review and meta-analysis
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Abstract
Patients with COVID-19 frequently manifest coagulation abnormalities and thrombotic events. In this meta-analysis, we aimed to explore the role of coagulopathy on the severity differences in patients with COVID-19. We conducted systematic literature search via Pubmed, Embase, Cochrane, WanFang Database, CNKI, and medRxiv from December 1, 2019 to May 1, 2020, to identify all original studies that reports on coagulation parameters (D-dimer, PLT, PT, APTT, and FIB) during COVID-19 infection. Thereafter, we compared the coagulation parameters between less severe and more severe cases. All Statistical analyses were performed via Stata14.0 software. A total of 3,952 confirmed COVID-19 infected patients were included from 25 studies. Patients with severe COVID-19 infection exhibited significantly higher levels of D-dimer, PT, and FIB (SMD 0.83, 95% CI: 0.70-0.97, I 2 56.9%; SMD 0.39, 95% CI: 0.14-0.64, I 2 77.9%; SMD 0.35, 95% CI: 0.17-0.53, I 2 42.4% respectively). However, difference in PLT and APTT levels between less severe and more severe patients was not statistically significant (SMD-0.26, 95% CI:-0.56-0.05, I 2 82.2%; SMD-0.14,95% CI: −0.45-0.18, I 2 75.5% respectively) This meta-analysis revealed coagulopathy is associated with the severity of COVID-19. Notably, D-dimer, PT, and FIB are the dominant parameters that should be considered in evaluating coagulopathy in COVID-19 patients.
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SciScore for 10.1101/2020.07.15.20154138: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization Inclusion and exclusion criteria: The inclusion criteria were as follows: (1) Original studies focused on clinical characteristics of patients with COVID-19 including observational study, case-control studies, cohort studies, and randomized control studies; (2) patients were categorized into less and more severe groups; (3) the coagulation parameters between groups were described. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources We conducted a literature search on the electronic databases including Pubmed, Embase, Cochrane, WanFang … SciScore for 10.1101/2020.07.15.20154138: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization Inclusion and exclusion criteria: The inclusion criteria were as follows: (1) Original studies focused on clinical characteristics of patients with COVID-19 including observational study, case-control studies, cohort studies, and randomized control studies; (2) patients were categorized into less and more severe groups; (3) the coagulation parameters between groups were described. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources We conducted a literature search on the electronic databases including Pubmed, Embase, Cochrane, WanFang Database, CNKI and medRxiv for reports published from December 1, 2019 to May 1, 2020 using a combination of the following keywords: “COVID-19” or “2019 novel coronavirus infection” or “SARS-CoV-2” and” characteristics” or” coagulopathy” or “coagulation”. Pubmedsuggested: (PubMed, RRID:SCR_004846)Embasesuggested: (EMBASE, RRID:SCR_001650)Cochranesuggested: (Cochrane Library, RRID:SCR_013000)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Besides, our meta-analysis has a few limitations. First, there was obvious heterogeneity among studies regarding definitions of the COVID-19 severity, and either subgroup or sensitivity analyses could not identify the heterogeneity source. Some selected studies did not report using mean and standard deviation, however, they gave estimates by median and quartile which may lead to deviation and effect heterogeneity. We excluded the low-quality studies to maintain the reliability of the conclusion. Second, this meta-analysis was conducted for studies that failed to describe all relevant characteristics of individual patients and it was difficult to adjust on the potentially confounding factors such as comorbidity and treatment (including use of anticoagulation or glucocorticoid). Finally, we included retrospective studies in the meta-analysis and there are risks of bias in the data collected. In conclusion, coagulopathy is associated with the severity of COVID-19. The D-dimer, PT, and FIB are dominant parameters for evaluating coagulopathy in COVID-19. COVID-19 associated coagulopathy has different features from DIC, therefore, it is necessary to closely monitor the dynamics of coagulation parameters.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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