The association between mortality due to COVID-19 and coagulative parameters: a systematic review and meta-analysis study

Alireza Abdollahi; Saeed Nateghi; Zahra Panahi; Seyed Hassan Inanloo; Samaneh Salarvand; Seyed Morteza Pourfaraji

doi:10.1186/s12879-024-10229-y

The association between mortality due to COVID-19 and coagulative parameters: a systematic review and meta-analysis study

BMC Infect Dis. 2024 Dec 2;24(1):1373. doi: 10.1186/s12879-024-10229-y.

Authors

Alireza Abdollahi¹, Saeed Nateghi², Zahra Panahi³, Seyed Hassan Inanloo⁴, Samaneh Salarvand⁵, Seyed Morteza Pourfaraji⁶

Affiliations

¹ Department of Pathology, School of Medicine, IKHC, Teheran University of Medical Sciences, Tehran, Iran.
² Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran.
³ School of Medicine, Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Department of Urology, Sina Hospital Tehran University of Medical Sciences, Tehran, Iran.
⁵ Department of Pathology, School of Medicine, IKHC, Teheran University of Medical Sciences, Tehran, Iran. sm.salarvand@gmail.com.
⁶ School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Aims and objectives: This systematic review and meta-analysis study evaluated the association between mortality due to COVID-19 and coagulative factors.

Methods: A systematic search was conducted on electronic databases including PubMed, Scopus, and the Web of Science from the beginning of the pandemic until October 2024 to identify relevant studies on COVID-19 patients and their laboratory findings related to coagulation markers and mortality outcome. Eligibility criteria were defined based on the PICO framework, and data extraction was performed by two authors independently using a standardized sheet. Statistical analysis was accomplished using the random effects model, and heterogeneity among studies was assessed using the I² test. R and RStudio were used for statistical analysis and visualization.

Results: Our systematic literature search yielded 6969 studies, with 48 studies meeting the inclusion criteria for our meta-analysis. The mean platelet count was significantly lower in deceased COVID-19 patients compared to survivors (20.58), while activated partial thromboplastin time (aPTT) and fibrinogen levels did not show significant differences. The pooled mean difference of D-Dimer, International Normalized Ratio (INR), and prothrombin time (PT) were significantly lower in survived patients (-2.45, -0.10, and -0.84, respectively). These findings suggest that platelet count, D-Dimer, INR, and PT may serve as potential indicators of mortality in COVID-19 patients.

Conclusion: The results of our systematic review and meta-analysis revealed a significant reduction in the pooled platelet count among deceased individuals when compared to survivors. However, no significant distinctions were observed in the pooled mean activated aPTT and fibrinogen levels between the deceased and survivor groups. On the other hand, there were noticeable variations in the pooled estimated mean of INR, PT, and D-Dimer levels, with significantly higher values in the deceased group compared to those who survived.

Keywords: COVID-19; Coagulopathy; D-dimers; Fibrinogen; Meta-analysis; Mortality; Prothrombin time.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Blood Coagulation
COVID-19* / blood
COVID-19* / mortality
Fibrin Fibrinogen Degradation Products* / analysis
Fibrin Fibrinogen Degradation Products* / metabolism
Fibrinogen / analysis
Fibrinogen / metabolism
Humans
International Normalized Ratio
Partial Thromboplastin Time
Platelet Count
Prothrombin Time
SARS-CoV-2

Substances

Fibrin Fibrinogen Degradation Products
fibrin fragment D
Fibrinogen