Abstract 15485: Hematological Changes and Coagulation Dysfunction in 633 Patients With Covid-19

Introduction: A previously unknown coronavirus was discovered from patients with pneumonia. The disease caused by this virus was named as coronavirus disease 2019 (COVID-19). In addition to pulmonary manifestations, hematological changes such as lymphopenia, thrombocytopenia, and coagulation dysfunction can also be found in COVID-19 patients, and the mechanism is still unclear. Methods: A total of 633 COVID-19 patients from Wuhan hospital of China were retrospectively analyzed. Clinical case data of all patients were collected, including gender, age, chronic underlying diseases, outcome, and blood laboratory test results. The hematological features of COVID-19 patients and the factors affecting their outcome were analyzed. Results: The median age was 62 years ( IQR; 51.0-70.0) and 330 (52%) were men. Lymphopenia ( lymphocyte count, 1.0 х10 9 / L [IQR, 0.7-1.4]) occurred in 317/607 patients (52%), prolonged prothrombin time (13.8 seconds [IQR, 13.1-15.1]) in 289/486 patients (59%), increased D-Dimer level (0.7 mg/L[IQR,0.2-2.9]) in 230/411 patients (57%) and increased C-reactive protein levels (10.7 mg/L [IQR, 2.2-49.7]) in 217/426 patients (51%). Compared with the survival patients, death patients have higher white blood cell count (11.7 х 10 9 /L [IQR, 8.4 to 15.6]), neutrophil count (10.8 х 10 9 /L [IQR, 7.8 to 13.9]), neutrophil count/lymphocyte count (20.5 [IQR, 12.4-34.2]), activated partial thromboplastin time (36.8 seconds [IQR, 31.3-42.3]), prothrombin time (17.1 seconds [IQR, 14.7 to 19.7]), D-Dimer level (4.6 mg/L [IQR, 1.0 to 7.8]), C-reactive protein level (111.8 mg/L (IQR, 53.1 to 196.6), and low lymphocyte count (0.5 х 10 9 /L [IQR, 0.3 to 0.7]). The results of logistic multivariate regression analysis showed that age, neutrophil count, prothrombin time, and C-reactive protein were risk factors for patients with COVID-19. Conclusions: Hematological changes are common in patients with COVID-19. The early stage of the disease is mainly characterized by lymphopenia, and the late stage may be characterized by more severe lymphopenia, even neutrophils elevation, elevated C-reactive protein, and severe coagulation disorder. The pathogenesis may be mediated by a direct viral infection and/or indirect immunopathology.