Autopsy and Informatics Analysis Evidence Disturbed Haemostasis Progress in COVID-19: Medical Records from 407 Patients

Abstract Background: The progress of coagulation in COVID-19 patients with confirmed discharge status (decease or discharge) and the combination of the autopsy with the complete coagulation parameters were not well studied.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 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Informatics tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severities of COVID-19.Results: At the beginning of the hospitalization, platelet (PLT) had a significant decrease in critically ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer in critical patients were higher than those in mild and severe during the whole admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score also showed the high DIC level in critical patients. At the relatively late stage of non-survivors, the temporal changes of PLT count, 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 positive associations for the severities of disease. Autopsy data from 9 deceased patients also showed the DIC phenomena with prolonged PT, APTT, less PLT count and thrombosis in multiple organs.Conclusions: Combining autopsy data, time-sequential changes and informatics methods to explore the coagulation relevant indices among the different severities of the disease, helps guide the therapy and detect the prognosis in COVID-19 infection.