Prolonged prothrombin time as an early prognostic indicator of severe acute respiratory distress syndrome in patients with COVID-19 related pneumonia

• Published in: Current medical research and opinion Vol. 37; no. 1; p. 21
• Main Authors: Baranovskii, Denis S, Klabukov, Ilya D, Krasilnikova, Olga A, Nikogosov, Dimitri A, Polekhina, Natalia V, Baranovskaia, Delyara R, Laberko, Leonid A
• Format: Journal Article
• Language: English
• Published: England 02.01.2021
• Subjects: Adult; Aged; Aged, 80 and over; C-Reactive Protein - analysis; COVID-19 - complications; Female; Hospitalization; Humans; Intensive Care Units; International Normalized Ratio; Male; Middle Aged; Prognosis; Prothrombin Time; Respiratory Distress Syndrome - diagnosis; Respiratory Distress Syndrome - etiology; Respiratory Insufficiency; Retrospective Studies; SARS-CoV-2; Young Adult; COVID-19; SARS-CoV-2; C-reactive protein; pneumonia; prognostic indicator; prothrombin time; respiratory failure; coronavirus; coagulation
• ISSN: 1473-4877
• DOI: 10.1080/03007995.2020.1853510

Clinical observations demonstrated that COVID-19 related pneumonia is often accompanied by hematological and coagulation abnormalities including lymphopenia, thrombocytopenia, and prolonged prothrombin time. The evaluation of laboratory findings including coagulation and inflammation parameters may represent a promising approach for early determination of COVID-19 severity. In the present study, we aimed to identify laboratory parameters present upon admission in patients with COVID-19 related viral pneumonia and associated with an early in-hospital development of refractory respiratory failure or severe acute respiratory distress syndrome requiring treatment in an intensive care unit. We investigated differences in the C-reactive protein (CRP) and fibrinogen levels, prothrombin time (PT) and international normalized ratio (INR) between COVID-19 patients who had been transferred to an ICU within two weeks after admission (  = 82) and COVID-19 patients with stable course of the disease (  = 74). Multiple comparisons showed statistically significantly prolonged PT on admission in ICU-transferred COVID-19 patients (14.15 sec, median, CI 95% 13.4 ÷ 14.9) compared to the stable COVID-19 patients (13.25 sec, median, CI 95% 12.9 ÷ 13.6) ( -value = .0005). CRP levels upon admission were statistically significantly higher in ICU-transferred COVID-19 patients (132 mg/L, median, CI95% 113 ÷ 159) compared to the stable COVID-19 patients (51 mg/L, median, CI95% 33 ÷ 72) ( -value < .0001). On-admission fibrinogen and INR levels did not statistically significantly differ between ICU-transferred COVID-19 patients and stable COVID-19 patients. We suggest that CRP and PT levels present on admission in COVID-19 patients may be used as early prognostic markers of severe pneumonia requiring transfer to ICU.