中国におけるCOVID-19の凝固機能障害の有病率と影響．メタアナリシス

Prevalence and Impact of Coagulation Dysfunction in COVID-19 in China: A Meta-Analysis.

• Shanen Jin
• Yiyang Jin
• Bai Xu
• Jun Hong
• Xianghong Yang

抄録

背景:

このメタアナリシスの目的は、中国の COVID-19 患者における凝固機能障害の有病率を評価し、COVID-19 の重症度および予後と凝固障害の関連を明らかにすることである。

BACKGROUND:  The aim of this meta-analysis is to assess the prevalence of coagulation dysfunction in Chinese COVID-19 patients and to determine the association of coagulopathy with the severity and prognosis of COVID-19.

方法:

中国の COVID-19 患者におけるさまざまな異常凝固指標の有病率のメタ解析を行った。重症例と非重症例，非生存者と生存者の間で，それぞれ凝固指標の違いと DIC の発生率を比較した．

METHODS:  A meta-analysis of the prevalence of different abnormal coagulation indicators in COVID-19 patients in China was performed. The difference of coagulation indicators and the incidence of DIC were compared between severe cases and nonsevere cases as well as nonsurvivors and survivors, respectively.

結果:

COVID-19が確認された4,889人のCOVID-19入院患者を対象とした合計22件の中国の研究が含まれた。COVID-19患者の平均Dダイマー値は0.67μg/mL（95％信頼区間[CI]：0.56～0.78）で、29.3％（95％CI：20.1～38.5％）の患者でDダイマー値の上昇が認められた。重症患者では、非重症患者に比べてDダイマー値が有意に高く、プロトロンビン時間（PT）が延長していた。非生存者は生存者に比べて D-ダイマー値が有意に高く、PT の延長、血小板数の減少が認められた。COVID-19患者の合計6.2％（95％CI：2.6～9.9％）が播種性血管内凝固（DIC）を合併しており、非生存者の対数リスク比は生存者と比較して3.267（95％CI：2.191～4.342、=5.95、<0.05）であった。

RESULTS:  A total of 22 Chinese studies involving 4,889 confirmed COVID-19 inpatients were included. The average D-dimer value of COVID-19 patients is 0.67 µg/mL (95% confidence interval [CI]: 0.56-0.78), and 29.3% (95% CI: 20.1-38.5%) of patients showed elevated D-dimer values. Severe patients had significantly higher D-dimer levels and prolonged prothrombin time (PT) compared with nonsevere patients. Nonsurvivors had significantly higher D-dimer levels, prolonged PT, and decreased platelet count compared with survivors. In total, 6.2% (95% CI: 2.6-9.9%) COVID-19 patients were complicated by disseminated intravascular coagulation (DIC), in which the log risk ratio in nonsurvivors was 3.267 (95% CI: 2.191-4.342,  = 5.95,  < 0.05) compared with that in survivors.

結論:

中国人COVID-19入院患者における凝固障害の有病率は高く、異常な凝固指標とDICの両方が、これらのCOVID-19患者の重症度と予後不良と密接に関連している。したがって、COVID-19患者の凝固機能障害に注意を払うべきである。凝固指標の綿密なモニタリングと適切な抗凝固療法の適用は、中国のCOVID-19入院患者の予後を改善する可能性がある。

CONCLUSION:  The prevalence of coagulopathy in Chinese COVID-19 inpatients is high, and both the abnormal coagulation indicators and DIC are closely associated with the severity and poor prognosis of these COVID-19 patients. Therefore, attention should be paid to coagulation dysfunction in COVID-19 patients. Closely monitoring of coagulation indicators and application of appropriate anticoagulation may improve the prognosis of COVID-19 inpatients in China.

Georg Thieme Verlag KG Stuttgart · New York.