INR and COVID-19 severity and mortality: A systematic review with meta-analysis and meta-regression.
Adv Med Sci
; 66(2): 372-380, 2021 Sep.
Article
in English
| MEDLINE | ID: covidwho-1379020
ABSTRACT
OBJECTIVES:
D-dimer elevations, suggesting a pro-thrombotic state and coagulopathy, predict adverse outcomes in coronavirus disease 2019 (COVID-19). However, the clinical significance of other coagulation markers, particularly the international normalized ratio (INR), is not well established. We conducted a systematic review and meta-analysis of the INR in COVID-19.METHODS:
A literature search was conducted in PubMed, Web of Science and Scopus, between January 2020 and February 2021, for studies reporting INR values, measures of COVID-19 severity, and mortality (PROSPERO registration number CRD42021241468).RESULTS:
Thirty-eight studies in 7440 COVID-19 patients with low disease severity or survivor status during follow up (50 â% males, mean age 57 years) and 2331 with high severity or non-survivor status (60 â% males, mean age 69 years) were identified. The INR was significantly prolonged in patients with severe disease or non-survivor status than in patients with mild disease or survivor status (standard mean difference, SMD, 0.60; 95 â% confidence interval, CI 0.42 to 0.77; p â< â0.001). There was extreme between-study heterogeneity (I2 â= â90.2 â%; p â< â0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified. The Begg's and Egger's t-tests did not show publication bias. In meta-regression, the SMD of the INR was significantly associated with C-reactive protein (p â= â0.048) and D-dimer (p â= â0.001).CONCLUSIONS:
Prolonged INR values were significantly associated with COVID-19 severity and mortality. Both INR prolongation and D-dimer elevations can be useful in diagnosing COVID-19-associated coagulopathy and predicting clinical outcomes.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Fibrin Fibrinogen Degradation Products
/
Thrombophilia
/
International Normalized Ratio
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Prognostic study
/
Reviews
/
Systematic review/Meta Analysis
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Adv Med Sci
Journal subject:
Medicine
Year:
2021
Document Type:
Article
Affiliation country:
J.advms.2021.07.009
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