Coagulopathy in patients with Coronavirus Disease 2019 (COVID-19): A systematic review and meta-analysis

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, I2 56.9%; SMD 0.39, 95% CI: 0.14-0.64, I2 77.9%; SMD 0.35, 95% CI: 0.17-0.53, I242.4% 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, I2 82.2%; SMD-0.14,95% CI: -0.45-0.18, I2 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.