Risk stratification and prognostic value of basic coagulation parameters among COVID-19 patients

Background: COVID-19 is a viral disease caused by a new strain of
coronavirus. Currently, prognosis and risk stratification of COVID-19
patients is done by the disease's clinical presentation. Therefore,
identifying laboratory biomarkers for disease prognosis and risk
stratification of COVID-19 patients is critical for prompt treatment.
Therefore, the main objective of this study was to assess the risk
stratification and prognostic value of basic coagulation parameters and
factors associated with disease severity among COVID-19 patients,
Northwest Ethiopia. Methods: A follow-up study was conducted among
conveniently recruited COVID-19 patients attended from March to June 2021.
Socio-demographic and clinical data were collected using a structured
questionnaire and checklist, respectively. Prothrombin time (PT) and
activated partial thromboplastin time (APTT) were analyzed by the HUMACLOT
DUE PLUS® machine. Descriptive statistics were used to summarize the
socio-demographic and clinical characteristics of study participants.
Kruskal Wallis tests were used to compare the difference between
parametric and non-parametric continuous variables, respectively. The area
under the receiver operating characteristic curve (AUC) was used to
evaluate the value of PT and APTT in the risk stratification and disease
prognosis of COVID-19 patients. Ordinal logistic regression was used to
identify the factors associated with disease severity and prognosis. A
P-value < 0.05 was defined as statistically significant for all
results. Result: Baseline PT at a cut-off value ≥ 16.25 seconds
differentiated severe COVID-19 patients from mild and moderate patients
(AUC: 0.89, 95% CI: 0.83–0.95). PT also differentiated
mild COVID-19 patients from moderate and severe patients at
a cut-off value ≤ 15.35 seconds (AUC: 0.90, 95% CI:
0.84–0.96). Moreover, alcohol drinkers were 3.52 times more likely chance
of having severe disease than non-drinkers (95% CI: 1.41–8.81). A one-year
increment in age also increased the odds of disease severity by 6% (95%
CI: 3–9%). An increment of ≥ 0.65 seconds from the baseline PT predicted
poor prognosis (AUC: 0.93, 0.87–0.99).   Conclusions and
recommendations: Prolonged baseline PT was observed in severe COVID-19
patients. Prolonged baseline PT was also predicted to worsen prognosis. An
increase from the baseline PT was associated with worsen prognosis.
Therefore, PT can be used as a risk stratification and prognostic marker
in COVID-19 patients.