COVID-19 is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) which progresses to severe pneumonia in 10-15% of patients. The main complications are Acute Respiratory Distress (ARDS), multiple organ failure and intravascular coagulopathy.
Low platelet count is related with :
- Severity of disease.
- Risk of mortality in intensive care.
- High scores on Multiple Organ Dysfunction Score (MODS), Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II.
During an SARS outbreak, thrombocytopenia was found in 55% of patients and was suspected as a significant risk factor for mortality.
This research is to study whether thrombocytopenia is associated with severe COVID-19 infection.
Meta-analysis.
All documents reporting information on the number or level of thrombocytopenia in patients with COVID-19 with the definition of clinically severe disease fall into the inclusion criteria for this meta-analysis.
In 7 studies :
Severe COVID-19 patients showed lower platelet counts compared to milder conditions (average difference between 3 and 54×10 9/L).
In 2 studies :
Platelet counts were found to be lower in mild COVID-19 patients (average difference between 27 and 31×10 9/L).
The results showed :
- Platelet count decreased significantly in severe COVID-19 patients.
- Platelets decrease more in patients who do not recover.
- Platelet counts below normal limits are five times the risk of being severe COVID-19.
Discussion.
- The variation in the severity of COVID-19 is very broad, ranging from asymptomatic to critical.
- Biomarkers are needed for the identification of severe diseases in hospitalized patients.
- Platelet count is a simple, fast, economical parameter that can distinguish between COVID patients with or without severe disease.
- Thrombocytopenia is associated with a risk of becoming severe COVID-19 disease.
Thrombocytopenia often occurs in critical patients and leads to severe organ malfunction or physiological decompensation. The mechanism of thrombocytopenia in COVID-19 patients varies.
In SARS, a combination of viral infection and mechanical ventilation results in :
- Endothelial damage.
- Trigger platelet activation.
- Aggregation and thrombosis in the lungs.
Coronavirus can infect bone marrow elements, cause abnormal hematopoiesis or trigger an autoimmune response against blood cells.
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