Study of Coagulopathies in Covid 19 Positive Patients & Their Correlation with Outcome of Disease

INTRODUCTION

COVID-19 started in November 2019 as an infection with a new strain of Corona virus and spread across all geographic regions. It has been observed that various coagulation abnormalities are not infrequent in COVID-19. Bleeding and coagulation abnormalities have surfaced as one of the mechanisms that could be related to increased mortality associated with it. Through our work, we look forward to discovering more on this association & we believe our study could provide new insight that could save additional lives.

AIMS & OBJECTIVES

- To study coagulation abnormalities in Covid-19 Positive patients.

- To correlate these coagulation abnormalities with severity of disease and outcome of Covid-19 Positive patients.

Material & Methods:This is a prospective study being carried out on the Intensive Care Unit (ICU) admitted Covid 19 positive patients, in a tertiary care hospital. Fifty cases have been studied so far, to look for coagulation abnormalities. Covid 19 positive patients by RNA detection by RT PCR method, admitted in ICU of hospital have been investigated for Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT), Fibrinogen levels and D-Dimer levels.The results of these investigations were correlated with clinical condition of these ICU patients, to assess the prognosisand outcome, of Covid-19 Positive patients.

Results:

Fifty COVID positive patients admitted in ICU have been studied & out of these 19 patients eventually expired (Non-survivors group) and 31 recovered from their illness (Survivors group).

These fifty patients were investigated,at the time of presentation in ICU.

Prothrombin time (PT)was prolonged in Covid 19 positive patients. Prothrombin time (PT) values in theSurvivors group ranged from 13.47 to 15.36 seconds(Mean 14.42 seconds). Prothrombin time (PT) values in theNon-survivors group ranged from 13.63 to 15.43 seconds (Mean 14.53 seconds).Normal control of Prothrombin time (PT) was 13 seconds. Prothrombin time (PT) values in the Survivors group were compared with Non-survivors group with ap value = 0.865(statistically not significant).

Activated partial thromboplastin time (APTT)values in theSurvivors group ranged from 33.44 to 36.38 seconds(Mean 34.91 seconds). Activated partial thromboplastin time (APTT) values in theNon-survivors group ranged from 33.68 to 38.32 seconds(Mean 36.00 seconds). Normal control of activated partial thromboplastin time (APTT) was 34 seconds. Activated partial thromboplastin time (APTT) values in the Survivors group were compared with Non-survivors group with ap value = 0.397(statistically not significant).

Thrombin time (TT)values in theSurvivors group ranged from 17.61 to 19.81 seconds(Mean 18.71 seconds). Thrombin time (TT) values in theNon-survivors group ranged from 18.68 to 22.32 seconds(Mean 20.50 seconds). Normal control of thrombin time (TT) was 18 seconds. Thrombin time (TT) values in the Survivors group were compared with Non-survivors group with ap value = 0.072(statistically not significant).

Fibrinogen levelsin theSurvivors group ranged from 378 mgm/dl to 441mgm/dl(Mean 410mgm/dl). Fibrinogen levels in theNon-survivors group ranged from 331 mgm/dl to 419mgm/dl(Mean 375mgm/dl). Normal values for fibrinogen levels were 150 to 450 mgm/dl. Fibrinogen levels in the Survivors group were compared with Non-survivors group with ap value = 0.184(statistically not significant).

D-Dimer levelswere increased in Covid 19 positive patients. D-Dimer levels in theSurvivors group ranged from 854 ngm/ml to 1847ngm/ml(Mean 1401ngm/ml). D-Dimer levels in theNon-survivors group ranged from 1308 ngm/ml to 2858 ngm/ml(Mean 2083ngm/ml). Normal values for D-Dimer levels were 135 to 250 ngm/ml. D-Dimer levels in the Survivors group were compared with Non-survivors group with ap value = 0.130(statistically not significant).

Conclusion

Ours is a small single centre study, however, shows coagulopathies in Covid 19 positive patients. Although, there is a difference between coagulation abnormalities in survivor & non-survivor group of ICU patients but this difference is statistically not significant.