Correlation of Coagulation Parameters With Clinical Outcomes During the Coronavirus-19 Surge in New York: Observational Cohort

Abstract

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.

SciScore for 10.1101/2020.05.01.20087932: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	Although both male gender and black race were increased in those who died vs. those who were discharged, we did not get a significant association.

Table 2: Resources

Antibodies
Sentences	Resources
It is unclear what the elevation in D-Dimer levels actually signifies: There is evidence of both an increase in venous and arterial disease in COVID and many patients have been demonstrated to have antiphospholipid antibodies (12–14).	antiphospholipid suggested: None

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers …

SciScore for 10.1101/2020.05.01.20087932: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	Although both male gender and black race were increased in those who died vs. those who were discharged, we did not get a significant association.

Table 2: Resources

Antibodies
Sentences	Resources
It is unclear what the elevation in D-Dimer levels actually signifies: There is evidence of both an increase in venous and arterial disease in COVID and many patients have been demonstrated to have antiphospholipid antibodies (12–14).	antiphospholipid suggested: None

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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

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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