EHA Library - The official digital education library of European Hematology Association (EHA)

Abstract: EP837

Type: E-Poster Presentation

Session title: Infections in hematology (incl. supportive care/therapy)

Background:
COVID-19 is a new infectious disease. The risk of death depends on previous comorbidities, but prothrombin time and low platelets count are also related to death.

Aims:
In this study, risk factors for death on hospital admission were evaluated.

Methods:
We included patients admitted to the Emergency Department of University Hospital Clementino Fraga Filho (HUCFF), Federal University of Rio de Janeiro (UFRJ), Brazil, from March to May/2020 with laboratory-confirmed Covid-19 infection. A confirmed case was defined by a positive result on a reverse-transcriptase–polymerase-chain-reaction assay of a specimen collected on a nasopharyngeal swab secretion. Admission results were collected through retrospective review of medical records. Death was the primary outcome. Data were expressed as median (range), or n/N (%); P values were calculated by Mann-Whitney or Fisher’s exact test, as appropriate. A two-sided α of less than 0.05 was considered statistically significant.

Results:

Lab on arrival	Total (N=116)	Alive (N=85)	Dead (N=31)	P value	Reference values
	median (range)
Hemoglobin (g/dL)	13.3 (2.6-14.4)	13.4 (2.6-14.4)	12.3 (8.2-16.5	0.210	13.5-18.0 g/dL
White blood cell count (X 103/mm3)	7.4 (2.4-26.7)	7.1 (2.4-26.7)	8.6 (3.9-20.5)	0.060	4.0-11.0 X 103/mm3
Neutrophil count (X 103/mm3)	5.8 (0.75-23.2)	5.4 (0.8-23.2)	6.9 (3.1-18.4)	0.037	2.5-6.4 X 103/mm3
Lymphocyte count (X 103/mm3)	1.0 (0.2-3.8)	1.0 (0.2-3.8)	0.9 (0.2-2.7)	0.069	1.5-3.9 X 103/mm3
Neutrophil/Lymphocyte ratio	5.6 (0.5-98.0)	5.1 (0.5-22.5)	7.4 (254-98)	0.012	-
Platelet count (X 103/mm3)	206.5 (59.0-619.0)	212.0 (59.0-550.0)	184.0 (75.0-619.0)	0.330	150.0-450.0 X 103/mm3
CRP mg/dL	114.5 (0.4-424.0)	102.7 (0.4-351.8)	174.4 (5.0-424.0)	0.004	0.-1.0
LDH	393 (139-1,494)	376 (139-1,494)	478 (228-1,047)	0.009	140-271 U/L
	n/N (%)
CRP high (≥ 115 mg/dL	57/114 (50)	35/84 (42)	22/30 (73)	0.005	-
LDH high (≥400 U/L)	52/110 (47)	34/82 (42)	18/28 (64)	0.049	-

Table 1: Laboratory findings of patients infected with Sars-Cov-2.

PT: prothrombin time; INR: international normalized ratio; APTT: activated prothrombin time; CRP: C-reactive protein; LDH: lactic dehydrogenase

We analysed 116 patients. The median age was 61 years (range 22-94), and most were male (55%). Ninety-nine (85%) had one or more chronic underlying diseases, mostly hypertension (69%). Ninety-six (83%) patients had pulmonary CT scan compatible with viral pneumonia on admission, 87% necessitated supplementary oxygen therapy, 38% needed mechanical ventilation, of which 71% died. Thirty-one (27%) patients died. Non-survivors were older (66 X 59 years; p=0.077), had a higher proportion of cardiopathy (45% X 13%; p=0.001), renal failure (36% X 9%; p=0.002) and diabetes (52% x 31%; p=0.050), and on hospital arrival, higher neutrophils counts (6.9 x 103/mm3 X 5.4x103/mm3; p=0,037), higher neutrophils / lymphocytes ratio (7.4 X 5.1; p=0.012), higher CRP (174.4 X 102.7; p=0.004) and higher LDH (478 X 376; p=0.009). Level of hemoglobin, white blood cells, RDW, platelet count, PT and APTT were similar in survivors and non-survivors. Most patients (97%) received any low molecular weight heparin (LMWH). All patients who died received LMWH.

Summary/Conclusion:
That patients admitted with COVID-19 with respiratory symptoms who needed mechanical ventilation had a high mortality rate (71%). On admission, cardiopathy, renal failure and CRP level were independently predictive of death. Basic coagulation profile and blood counts (CBC) on admission were similar between alive and dead cases. Almost universal use of low molecular weight heparin precluded any further discussion on this subject.

Keywords:Activated protein C, COVID-19, Infection