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Autopsy and statistical evidence of disturbed hemostasis progress in COVID-19: medical records from 407 patients

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单位: [1]Cent South Univ, Xiangya Hosp 3, Dept Hematol, Changsha 410013, Hunan, Peoples R China [2]Tongji Univ, Sch Med, Dept Regenerat Med, 1239 Siping Rd, Shanghai 200092, Peoples R China [3]China Univ Polit Sci & Law, Scientometr & Evaluat Ctr Rule Law, Beijing 100088, Peoples R China [4]Cent South Univ, Sch Comp Sci & Engn, Changsha 410083, Peoples R China [5]Cent South Univ, Xiangya Hosp 3, Dept Cardiov, Changsha 410013, Hunan, Peoples R China [6]Tongji Univ, Tongji Hosp, Reprod Med Ctr, Shanghai 200065, Peoples R China [7]Hunan Yuanpin Cell Technol Co Ltd, Stem Cell & Regenerat Med Engn Res Ctr Hunan Prov, 102 Dongwu Rd, Changsha 410100, Hunan, Peoples R China [8]Huazhong Univ Sci & Technol, Dept Forens Med, Tongji Med Coll, 13 Hangkong Rd, Wuhan 430030, Hubei, Peoples R China [9]Univ South China, Dept Spinal Surg, Affiliated Hosp 1, Hengyang 421002, Hunan, Peoples R China
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关键词: COVID-19 Thrombosis Hemostasis Autopsy Statistics

摘要:
Background The progression of coagulation in COVID-19 patients with confirmed discharge status and the combination of autopsy with complete hemostasis parameters have not been well studied. Objective To clarify the thrombotic phenomena and hemostasis state in COVID-19 patients based on epidemiological statistics combining autopsy and statistical analysis. Methods Using autopsy results from 9 patients with COVID-19 pneumonia and the medical records of 407 patients, including 39 deceased patients whose discharge status was certain, time-sequential changes in 11 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Statistical tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severity of COVID-19. Results At the beginning of hospitalization, platelet (PLT) counts were significantly reduced in critically ill patients compared with severely or mildly ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer levels in critical patients were increased compared with mild and severe patients during the entire admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score was also high in critical patients. In the relatively late stage of nonsurvivors, the temporal changes in PLT count, PT, and D-dimer levels were significantly different from those in survivors. A random forest model indicated that the most important feature was PT followed by D-dimer, indicating their positive associations with disease severity. Autopsy of deceased patients fulfilling diagnostic criteria for DIC revealed microthromboses in multiple organs. Conclusions Combining autopsy data, time-sequential changes and statistical methods to explore hemostasis-relevant indices among the different severities of the disease helps guide therapy and detect prognosis in COVID-19 infection.

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出版当年[2020]版:
大类 | 4 区 医学
小类 | 4 区 血液学 4 区 外周血管病
最新[2025]版:
大类 | 3 区 医学
小类 | 3 区 血液学 3 区 外周血管病
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出版当年[2019]版:
Q3 PERIPHERAL VASCULAR DISEASE Q3 HEMATOLOGY
最新[2023]版:
Q2 HEMATOLOGY Q2 PERIPHERAL VASCULAR DISEASE

影响因子: 最新[2023版] 最新五年平均 出版当年[2019版] 出版当年五年平均 出版前一年[2018版] 出版后一年[2020版]

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第一作者单位: [1]Cent South Univ, Xiangya Hosp 3, Dept Hematol, Changsha 410013, Hunan, Peoples R China
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通讯机构: [7]Hunan Yuanpin Cell Technol Co Ltd, Stem Cell & Regenerat Med Engn Res Ctr Hunan Prov, 102 Dongwu Rd, Changsha 410100, Hunan, Peoples R China [9]Univ South China, Dept Spinal Surg, Affiliated Hosp 1, Hengyang 421002, Hunan, Peoples R China
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