Platelet-to-international normalized ratio as a predictor for mortality in moderate to severely ill patients with SARS-CoV-2 infection

Objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a high mortality and the non-survivors were reported to have a severe form of coagulopathy during the coronavirus disease pandemic. This study was performed to understand hemostatic abnormalities and their relationship to outcomes in patients with moderate to severe SARS-CoV-2 infection. We also evaluated the role of the platelet-to-international normalized ratio (INR) ratio as a predictor of mortality and compared it with other commonly used coagulopathy scores. Materials and Methods This study was conducted on all adult patients of SARS-CoV-2 infection who were hospitalized at a tertiary care hospital in Central India between March 1 st , 2020, and June 30 th , 2021. A cross-sectional study design was used and hemostatic abnormalities among survivors and non-survivors were compared and the role of platelet to INR ratio as a predictor of mortality was evaluated. Statistical analysis A descriptive statistical analysis was conducted using the R-Statistical language (version 4.0.3). Appropriate statistical tests were used for comparison and P < 0.05 was used to classify the difference between the two groups as significant. A receiver-operating curve analysis was performed to identify meaningful predictors of mortality. Results Of 941 individuals with moderate to severe SARS-CoV-2 infection, included in the study, 291 (30.9%) died. Non-survivors were older and had significantly higher prothrombin time, INR, D-dimer, and activated partial thromboplastin time levels. Platelet-INR ratio was found to have higher predictability for mortality, as compared to disseminated intravascular coagulation and score or sepsis induced coagulopathy scores. Conclusions The platelet-INR ratio is an indicator of the severity of abnormal hemostasis abnormality and emerged as a promising biomarker for predicting prognosis in patients with coronavirus disease 2019 pneumonia in the present study.