Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan
Abstract Background Severe acute respiratory syndrome coronavirus 2 infection causes systemic immune overresponse (cytokine storm), which can lead to microthrombi and dysfunction of coagulation such as disseminated intravascular coagulation (DIC) of sepsis. Coronavirus disease 2019 (COVID-19) coagul...
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BMC
2025-06-01
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| Series: | Thrombosis Journal |
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| Online Access: | https://doi.org/10.1186/s12959-025-00747-3 |
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| author | Ryo Hisamune Kazuma Yamakawa Noritaka Ushio Katsunori Mochizuki Tadashi Matsuoka Yutaka Umemura Mineji Hayakawa Hirotaka Mori Akira Endo Takayuki Ogura Atsushi Hirayama Hideo Yasunaga Takashi Tagami Kohji Okamoto Akira Takasu |
| author_facet | Ryo Hisamune Kazuma Yamakawa Noritaka Ushio Katsunori Mochizuki Tadashi Matsuoka Yutaka Umemura Mineji Hayakawa Hirotaka Mori Akira Endo Takayuki Ogura Atsushi Hirayama Hideo Yasunaga Takashi Tagami Kohji Okamoto Akira Takasu |
| author_sort | Ryo Hisamune |
| collection | DOAJ |
| description | Abstract Background Severe acute respiratory syndrome coronavirus 2 infection causes systemic immune overresponse (cytokine storm), which can lead to microthrombi and dysfunction of coagulation such as disseminated intravascular coagulation (DIC) of sepsis. Coronavirus disease 2019 (COVID-19) coagulopathy is known to occur mainly in the pulmonary microcirculation. We aimed to investigate hematological differences in coagulopathy between COVID-19 pneumonia and bacterial pneumonia. Methods We performed an observational cohort study using the Japanese REsearch of COVID-19 by assEmbling Real-world data (J-RECOVER) study database for COVID-19 patients and the Japan Medical Data Center (JMDC) database for bacterial pneumonia patients. The J-RECOVER database includes data from patients discharged between January 1 and September 31, 2020. The JMDC database covers patients emergently hospitalized from 2014 to 2022. We analyzed the association between hematological coagulopathy, systematic inflammation, and organ dysfunction in both groups after one-to-one propensity score matching. Results We enrolled 572 COVID-19 patients and 2,413 bacterial pneumonia patients who required mechanical ventilation. The COVID-19 group was younger, had higher intensive care unit admission rates, and lower mortality in comparison to the bacterial group (p < 0.05). On day 1, the two groups showed no significant differences in JAAM-2 and sepsis-induced coagulopathy criteria. After matching, platelet counts, antithrombin activity, and prothrombin time-international normalized ratio were consistently maintained within normal ranges in the COVID-19 group. However, trends in D-dimer and fibrin degradation products in the COVID-19 group were similar to those in the bacterial pneumonia group. Conclusions COVID-19 coagulopathy differs from bacterial septic DIC by exhibiting lower platelet consumption and minimal vascular hyperpermeability. Consequently, management strategies for COVID-19 coagulopathy should be distinct from those for septic DIC. |
| format | Article |
| id | doaj-art-0ea2569010154c4ca04b9650003914d4 |
| institution | DOAJ |
| issn | 1477-9560 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj-art-0ea2569010154c4ca04b9650003914d42025-08-20T02:39:44ZengBMCThrombosis Journal1477-95602025-06-0123111110.1186/s12959-025-00747-3Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in JapanRyo Hisamune0Kazuma Yamakawa1Noritaka Ushio2Katsunori Mochizuki3Tadashi Matsuoka4Yutaka Umemura5Mineji Hayakawa6Hirotaka Mori7Akira Endo8Takayuki Ogura9Atsushi Hirayama10Hideo Yasunaga11Takashi Tagami12Kohji Okamoto13Akira Takasu14Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical UniversityDepartment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical UniversityDepartment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical UniversityDepartment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical UniversityDepartment of Emergency and Critical Care Medicine, Keio University School of MedicineLOCOMOCO (Landmark Of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study GroupJ-RECOVER (Japanese multicenter REsearch of COVID-19 by assEmbling Real-World Data) Study GroupLOCOMOCO (Landmark Of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study GroupJ-RECOVER (Japanese multicenter REsearch of COVID-19 by assEmbling Real-World Data) Study GroupJ-RECOVER (Japanese multicenter REsearch of COVID-19 by assEmbling Real-World Data) Study GroupJ-RECOVER (Japanese multicenter REsearch of COVID-19 by assEmbling Real-World Data) Study GroupJ-RECOVER (Japanese multicenter REsearch of COVID-19 by assEmbling Real-World Data) Study GroupJ-RECOVER (Japanese multicenter REsearch of COVID-19 by assEmbling Real-World Data) Study GroupLOCOMOCO (Landmark Of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study GroupDepartment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical UniversityAbstract Background Severe acute respiratory syndrome coronavirus 2 infection causes systemic immune overresponse (cytokine storm), which can lead to microthrombi and dysfunction of coagulation such as disseminated intravascular coagulation (DIC) of sepsis. Coronavirus disease 2019 (COVID-19) coagulopathy is known to occur mainly in the pulmonary microcirculation. We aimed to investigate hematological differences in coagulopathy between COVID-19 pneumonia and bacterial pneumonia. Methods We performed an observational cohort study using the Japanese REsearch of COVID-19 by assEmbling Real-world data (J-RECOVER) study database for COVID-19 patients and the Japan Medical Data Center (JMDC) database for bacterial pneumonia patients. The J-RECOVER database includes data from patients discharged between January 1 and September 31, 2020. The JMDC database covers patients emergently hospitalized from 2014 to 2022. We analyzed the association between hematological coagulopathy, systematic inflammation, and organ dysfunction in both groups after one-to-one propensity score matching. Results We enrolled 572 COVID-19 patients and 2,413 bacterial pneumonia patients who required mechanical ventilation. The COVID-19 group was younger, had higher intensive care unit admission rates, and lower mortality in comparison to the bacterial group (p < 0.05). On day 1, the two groups showed no significant differences in JAAM-2 and sepsis-induced coagulopathy criteria. After matching, platelet counts, antithrombin activity, and prothrombin time-international normalized ratio were consistently maintained within normal ranges in the COVID-19 group. However, trends in D-dimer and fibrin degradation products in the COVID-19 group were similar to those in the bacterial pneumonia group. Conclusions COVID-19 coagulopathy differs from bacterial septic DIC by exhibiting lower platelet consumption and minimal vascular hyperpermeability. Consequently, management strategies for COVID-19 coagulopathy should be distinct from those for septic DIC.https://doi.org/10.1186/s12959-025-00747-3Antithrombin activityCOVID-19Disseminated intravascular coagulationSepsisThrombocytopenia |
| spellingShingle | Ryo Hisamune Kazuma Yamakawa Noritaka Ushio Katsunori Mochizuki Tadashi Matsuoka Yutaka Umemura Mineji Hayakawa Hirotaka Mori Akira Endo Takayuki Ogura Atsushi Hirayama Hideo Yasunaga Takashi Tagami Kohji Okamoto Akira Takasu Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan Thrombosis Journal Antithrombin activity COVID-19 Disseminated intravascular coagulation Sepsis Thrombocytopenia |
| title | Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan |
| title_full | Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan |
| title_fullStr | Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan |
| title_full_unstemmed | Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan |
| title_short | Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan |
| title_sort | time series differences in coagulopathy in mechanically ventilated covid 19 and bacterial pneumonia patients a nationwide observational study in japan |
| topic | Antithrombin activity COVID-19 Disseminated intravascular coagulation Sepsis Thrombocytopenia |
| url | https://doi.org/10.1186/s12959-025-00747-3 |
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