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Minerva Respiratory Medicine 2022 June;61(2):46-53

DOI: 10.23736/S2784-8477.21.01982-3


language: English

Prothrombin time, international normalized rate and in-hospital mortality in COVID-19

Panagiotis PALIOGIANNIS 1 , Angelo ZINELLU 2, Arduino A. MANGONI 3, Antonio PAZZOLA 4, Francesco L. BANDIERA 5, Antonio SPANO 1, Chiara SANNA 1, Valentina SCANO 1, Sara S. FOIS 1, Verdiana MUSCAS 1, Elena MASOTTO 1, Stefano DORE 1, Vito FIORE 1, Pietro PIRINA 1, Ciriaco CARRU 2, Alessandro G. FOIS 1

1 Unit of Anatomic Pathology and Histology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; 2 Unit of Clinical Biochemistry and Clinical Molecular Pathology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy; 3 College of Medicine and Public Health, Discipline of Clinical Pharmacology, Flinders University, Adelaide, Australia; 4 Unit of Medical Oncology, University Hospital of Sassari, Sassari, Italy; 5 Unit of Internal Medicine, University Hospital of Sassari, Sassari, Italy

BACKGROUND: Blood coagulation alterations are frequent in patients with Coronavirus disease 2019 (COVID-19), particularly in those with severe forms. We investigated the association between standard parameters of coagulation and in-hospital mortality in COVID-19.
METHODS: Demographic, clinical and laboratory data at hospital admission, including prothrombin time (PT), international normalized rate (INR), activated thromboplastin time (aPTT), and D-dimer were retrospectively collected in a consecutive series of 309 COVID-19 hospitalized patients. The associations between parameters of coagulation and in-hospital mortality were investigated with receiver operating characteristics (ROC), multiple regression and Kaplan-Meyer analyses.
RESULTS: In the overall population, 220 (71.2%) patients were discharged alive, whereas the remaining 89 (28.8%) died. Non-survivors had significantly higher INR (median: 1.20; IQR: 1.03-1.32 vs. 1.06; IQR: 1.02-1.11, P<0.001), PT (median: 12.0 sec; IQR: 11.1-14.0 vs. 11.4 sec; IQR: 11.0-11.9, P<0.001), aPTT (median: 25.1 sec; IQR: 22.7-29.6 vs. 23.4 sec; IQR: 21.4-25.1, P<0.001) and D-dimer (median: 1.36 µg/mL; IQR: 0.87-4.11 vs. 0.77 µg/mL; IQR: 0.43-1.58, P<0.001). In multivariate Cox regression analysis, both the INR (HR=1.8459; 95% CI: 1.0713-3.1806, P=0.027) and PT (HR=1.071; 95% CI: 1.0132-1.1303, P=0.015), but not the aPTT and D-dimer, remained independently associated with survival.
CONCLUSIONS: Both the PT and INR are independently associated with in-hospital mortality in COVID-19. The clinical utility of these parameters for risk stratification warrants further investigations.

KEY WORDS: Coronavirus; COVID-19; SARS-CoV-2; Thrombosis

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