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

Panagiotis Paliogiannis, Angelo Zinellu, Arduino A. Mangoni, Antonio Pazzola, Francesco L. Bandiera, Antonio Spano, Chiara Sanna, Valentina Scano, Sara S. Fois, Verdiana Muscas, Elena Masotto, Stefano Dore, Vito Fiore, Pietro Pirina, Ciriaco Carru, Alessandro G. Fois

Research output: Contribution to journalArticlepeer-review


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 PTand INRare independently associated with in-hospital mortality in COVID-19. The clinical utility of these parameters for risk stratification warrants further investigations.

Original languageEnglish
Pages (from-to)46-53
Number of pages8
JournalMinerva Respiratory Medicine
Issue number2
Publication statusPublished - Jun 2022


  • Coronavirus
  • COVID-19
  • SARS-CoV-2
  • Thrombosis


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