• Di MinnoMatteo Nicola DarioMND0000-0001-8059-3819Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy., Ilenia Calcaterra, Roberta Lupoli, Antonio Storino, Giorgio Alfredo Spedicato, Mauro Maniscalco, Alessandro Di Minno, and Pasquale Ambrosino.
• Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy.
• J Clin Med. 2020 Jul 15; 9 (7).

BackgroundComplications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters.MethodsData on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated.ResultsSixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: -0.74; 95%CI: -1.01, -0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: -0.60, 95%CI: -0.82, -0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen.ConclusionsSignificant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients.

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