Dynamic trajectory of platelet-related indicators and survival of severe COVID-19 patients
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RESEARCH LETTER
Dynamic trajectory of platelet‑related indicators and survival of severe COVID‑19 patients Jieyu He1†, Yongyue Wei1†, Jiao Chen2, Feng Chen1, Wei Gao2* and Xiang Lu1,2*
Dear Editor, Previous studies have found approximately a 30% cumulative incidence for thrombosis in critically unwell patients, almost all whom already present impaired platelets function and activity, with COVID-19 in the intensive care unit (ICU) [1, 2]. We aimed to explore the association between platelet-related laboratory indicators and prognosis in critically ill patients with COVID-19. All the severe and critically ill COVID-19 patients (Table 1) diagnosed in Huangshi City, Hubei Province, China, till 6 March, 2020, were recruited in this study which were distributed in the three hospitals including Huangshi Central Hospital, Huangshi Hospital of Traditional Chinese Medicine, and Daye People’s Hospital. Laboratory examinations including routine blood tests, lymphocyte subsets, inflammatory or infection-related biomarkers, cardiac, renal, liver and coagulation function tests were obtained at admission and during hospitalization. The baseline laboratory measures with over 40% missing value were excluded from the analysis. Death in 28 days after admission to the hospital was the primary end point of this study. Patients discharge from hospital within 28 days or kept in hospitalization after 28 days
*Correspondence: [email protected]; [email protected] † Jieyu He and Yongyue Wei contributed equally to the work. 1 Department of Epidemiology and Biostatistics, School of Public Health, Center for Global Health, Nanjing Medical University, Nanjing 211166, China 2 Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Avenue, Nanjing 211166, China
were considered as censored outcome. Time-to-event outcome was defined for the following statistical models. The platelet-related indicators included platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), and platelet large cell ratio (P-LCR). Baseline indicators were dichotomized by the median to low and high groups. For each plateletrelated indicator with repeated examinations during hospitalization, trajectory analysis was performed to cluster the patients based on the dynamic time-series trend of the corresponding indicator, using R package traj [3]. According to the requirement of the method, patients during hospitalization with less than four observations of the specific indicator were classified as a separate cluster. Cox proportional hazards model with adjustment for age, gender, number of comorbidities were applied to test the association between dynamic trajectory of plateletrelated indicators and overall survival of COVID-19 patients. The patients at admission with high PLT (HR 0.28; 95% CI 0.11–0.69; P = 0.0057; Fig. 1a) were associated with the preferred survival; however, patients with high PDW (HR 2.52; 95% CI 1.17–5.44; P = 0.0185; Fig. 1b), high MPV (HR 3.73; 95%
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