Abstract Background: Cardiac injury and coagulation disorders have been two increasing concerns in the management of patients with severe coronavirus disease (COVID-19). Coagulation disorders in COVID-19 patients with cardiac injury have not been characterized. Methods: We analyzed the data of five COVID-19 patients with cardiac injury who had D-dimer surge (defined as a rapid increase in the D-dimer level in 72 h, from <5–21 μg/mL) during hospitalization, which were extracted from a registered retrospective study (ChiCTR2000031301). Clinical data and data on changes in coagulation parameters were collected, verified, and characterized. Results: Among these five patients, four had pre-existing cardiovascular or cerebrovascular diseases. D-dimer surge was accompanied with prolonged prothrombin time (PT) and reduced platelet count (PLT) and fibrinogen level. Three patients had an ISTH DIC score of 5 and met the criteria for overt DIC. All five patients needed invasive ventilation support and were incubated 0 to 6 days after the first D-dimer upper reference limit (URL) was reached. All five patients died within 10 days after the first D-dimer URL was reached. All five patients had observed D-dimer URL results 1 to 3 days before death. Conclusion: D-dimer surge in COVID-19 patients with cardiac injury surely leads to worse in-hospital outcome. D-dimer surge and concomitant DIC can be the leading causes of in-hospital death. Pre-existing cardiovascular or cerebrovascular diseases might pose a higher risk for developing these coagulation disorders. These findings can serve as hypothesis generating and need further clinical trials to confirm.
【저자키워드】 COVID-19, cardiac injury, Case series, coagulation disorders, D-dimer surge, 【초록키워드】 clinical trial, Hospitalization, D-dimer, outcome, invasive ventilation, Retrospective study, clinical, management, Patient, death, Platelet, fibrinogen, patients, D-dimer level, Hypothesis, Injury, Cerebrovascular disease, COVID-19 patient, criteria, Prothrombin time, cerebrovascular diseases, In-hospital death, Support, In-hospital, higher risk, severe coronavirus disease, Registered, rapid increase, disorder, upper reference limit, FIVE, coagulation disorder, defined, analyzed, collected, reduced, characterized, changes in, cause, reached, accompanied, incubated, coagulation parameter, five COVID-19 patient, patients died, 【제목키워드】 Pneumonia, D-dimer, Patient, Injury, coagulation disorder, case sery,