BMJ Open (Jun 2022)
Changes in laboratory value improvement and mortality rates over the course of the pandemic: an international retrospective cohort study of hospitalised patients infected with SARS-CoV-2
- ,
- Ramakanth Kavuluru,
- Xuan Wang,
- Paul Avillach,
- Florence Bourgeois,
- Kee Yuan Ngiam,
- Gabriel A Brat,
- Isaac Kohane,
- Tianxi Cai,
- Yuk-Lam Ho,
- Yuan Luo,
- Harrison G Zhang,
- Kelly Cho,
- Vincent Benoit,
- Antoine Neuraz,
- Chuan Hong,
- Sehi L'Yi,
- Griffin Weber,
- Bryce W Q Tan,
- Alba Gutiérrez-Sacristán,
- Clara-Lea Bonzel,
- Nathan P Palmer,
- Alberto Malovini,
- Valentina Tibollo,
- Meghan R Hutch,
- Molei Liu,
- Riccardo Bellazzi,
- Luca Chiovato,
- Fernando J Sanz Vidorreta,
- Trang T Le,
- William Yuan,
- Bertrand Moal,
- Michele Morris,
- David A Hanauer,
- Sarah Maidlow,
- Kavishwar Wagholikar,
- Shawn Murphy,
- Hossein Estiri,
- Adeline Makoudjou,
- Patric Tippmann,
- Jeffery Klann,
- Robert W Follett,
- Nils Gehlenborg,
- Gilbert S Omenn,
- Zongqi Xia,
- Arianna Dagliati,
- Shyam Visweswaran,
- Lav P Patel,
- Danielle L Mowery,
- Emily R Schriver,
- Malarkodi Jebathilagam Samayamuthu,
- Sara Lozano-Zahonero,
- Daniela Zöller,
- Amelia L M Tan,
- Byorn W L Tan,
- John H Holmes,
- Petra Schubert,
- Brett K. Beaulieu-Jones,
- Miguel Pedrera-Jiménez,
- Noelia García-Barrio,
- Pablo Serrano-Balazote,
- Andrew South
Affiliations
- UK Heat Illness Advisory Group, London, UK
- Ramakanth Kavuluru
- Institute for Biomedical Informatics, University of Kentucky, Lexington, Kentucky, USA
- Xuan Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Paul Avillach
- Aarhus University, Aarhus, Denmark
- Florence Bourgeois
- 2 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Kee Yuan Ngiam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Gabriel A Brat
- 1 Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Isaac Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Yuan Luo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Harrison G Zhang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Kelly Cho
- Million Veteran Program (MVP) Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA
- Vincent Benoit
- IT department, Innovation & Data, APHP Greater Paris University Hospital, Paris, France
- Antoine Neuraz
- Biostatistics, Imagine Institute, AP*HP, Necker Hospital, Paris, France
- Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Sehi L'Yi
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Griffin Weber
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Bryce W Q Tan
- Department of Medicine, National University Hospital, Singapore
- Alba Gutiérrez-Sacristán
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Nathan P Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Lombardia, Italy
- Valentina Tibollo
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Lombardia, Italy
- Meghan R Hutch
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois, USA
- Molei Liu
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
- Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Lombardia, Italy
- Fernando J Sanz Vidorreta
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
- Trang T Le
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- William Yuan
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Bertrand Moal
- IAM unit, Bordeaux University Hospital, Bordeaux, France
- Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- David A Hanauer
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Sarah Maidlow
- MICHR Informatics, University of Michigan, Ann Arbor, Michigan, USA
- Kavishwar Wagholikar
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Shawn Murphy
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Hossein Estiri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Adeline Makoudjou
- Institute of Medical Biometry and Statistics, University of Freiburg Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Patric Tippmann
- Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Freiburg, Baden-Württemberg, Germany
- Jeffery Klann
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Robert W Follett
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
- Nils Gehlenborg
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Gilbert S Omenn
- Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
- Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Arianna Dagliati
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Kansas, USA
- Lav P Patel
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
- Danielle L Mowery
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Emily R Schriver
- Data Analytics Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Malarkodi Jebathilagam Samayamuthu
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Sara Lozano-Zahonero
- Institute of Medical Biometry and Statistics, University of Freiburg Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Daniela Zöller
- Institute of Medical Biometry and Statistics, University of Freiburg Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Amelia L M Tan
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Byorn W L Tan
- Department of Medicine, National University Hospital, Singapore
- John H Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Petra Schubert
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Brett K. Beaulieu-Jones
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Miguel Pedrera-Jiménez
- Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
- Noelia García-Barrio
- Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
- Pablo Serrano-Balazote
- Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
- Andrew South
- Department of Pediatrics, Section of Nephrology, Wake Forest University, Winston Salem, North Carolina, USA
- DOI
- https://doi.org/10.1136/bmjopen-2021-057725
- Journal volume & issue
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Vol. 12,
no. 6
Abstract
Objective To assess changes in international mortality rates and laboratory recovery rates during hospitalisation for patients hospitalised with SARS-CoV-2 between the first wave (1 March to 30 June 2020) and the second wave (1 July 2020 to 31 January 2021) of the COVID-19 pandemic.Design, setting and participants This is a retrospective cohort study of 83 178 hospitalised patients admitted between 7 days before or 14 days after PCR-confirmed SARS-CoV-2 infection within the Consortium for Clinical Characterization of COVID-19 by Electronic Health Record, an international multihealthcare system collaborative of 288 hospitals in the USA and Europe. The laboratory recovery rates and mortality rates over time were compared between the two waves of the pandemic.Primary and secondary outcome measures The primary outcome was all-cause mortality rate within 28 days after hospitalisation stratified by predicted low, medium and high mortality risk at baseline. The secondary outcome was the average rate of change in laboratory values during the first week of hospitalisation.Results Baseline Charlson Comorbidity Index and laboratory values at admission were not significantly different between the first and second waves. The improvement in laboratory values over time was faster in the second wave compared with the first. The average C reactive protein rate of change was –4.72 mg/dL vs –4.14 mg/dL per day (p=0.05). The mortality rates within each risk category significantly decreased over time, with the most substantial decrease in the high-risk group (47.1% in March–April 2020 vs 30.8% in November 2020 to January 2021, p<0.001) and a moderate decrease in the intermediate-risk group (21.5% in March–April 2020 vs 14.3% in November 2020 to January 2021, p<0.001).Conclusions Admission profiles of patients hospitalised with SARS-CoV-2 infection did not differ greatly between the first and second waves of the pandemic, but there were notable differences in laboratory improvement rates during hospitalisation. Mortality risks among patients with similar risk profiles decreased over the course of the pandemic. The improvement in laboratory values and mortality risk was consistent across multiple countries.
