Autopsy and Informatics Analysis Evidence Coagulopathy Progress in COVID-19 Patients

Background The outbreak of COVID-19 around the world resulted in more than 480 thousand deaths. Objective To clarify the thrombotic phenomena with coagulation progress in COVID-19 patients based on epidemiological statistics combining the autopsy and informatics analysis. Methods Using 9 autopsy results with COVID-19 pneumonia and the medical records of 407 patients including 39 deceased ones whose discharge status was certain, time-sequential changes of 11 coagulation relevant indices within mild, severe and critical infection throughout hospitalization according to NHC guidelines were evaluated. Informatics tools were applied to calculate the importance and correlation between them and the progression of thrombosis. Results At the beginning of the hospitalization, PLT had a significant decrease in critically ill patients. GLU, PT, APTT, and D-dimer in critical patients were higher than those in mild and severe during the whole admission period. The ISTH DIC score also showed the continuous overt DIC in critical patients. At the late stage of non-survivors, the dynamic profiles of PLT, PT, and D-dimer were significantly different from survivors. A random forest model indicated that the most important feature was PT, followed by D-dimer, indicating their crucial roles for the progression of disease. Conclusions COVID-19 is constantly spreading wildly around the world, combining autopsy data, time-sequential profiles and informatics methods to explore the dynamic changes of coagulation relevant indices throughout the course of the disease deterioration, which helps guide the therapy and detect the prognosis in different level of COVID-19 infection.