npj Digital Medicine (Jun 2022)
International electronic health record-derived post-acute sequelae profiles of COVID-19 patients
- Harrison G. Zhang,
- Arianna Dagliati,
- Zahra Shakeri Hossein Abad,
- Xin Xiong,
- Clara-Lea Bonzel,
- Zongqi Xia,
- Bryce W. Q. Tan,
- Paul Avillach,
- Gabriel A. Brat,
- Chuan Hong,
- Michele Morris,
- Shyam Visweswaran,
- Lav P. Patel,
- Alba Gutiérrez-Sacristán,
- David A. Hanauer,
- John H. Holmes,
- Malarkodi Jebathilagam Samayamuthu,
- Florence T. Bourgeois,
- Sehi L’Yi,
- Sarah E. Maidlow,
- Bertrand Moal,
- Shawn N. Murphy,
- Zachary H. Strasser,
- Antoine Neuraz,
- Kee Yuan Ngiam,
- Ne Hooi Will Loh,
- Gilbert S. Omenn,
- Andrea Prunotto,
- Lauren A. Dalvin,
- Jeffrey G. Klann,
- Petra Schubert,
- Fernando J. Sanz Vidorreta,
- Vincent Benoit,
- Guillaume Verdy,
- Ramakanth Kavuluru,
- Hossein Estiri,
- Yuan Luo,
- Alberto Malovini,
- Valentina Tibollo,
- Riccardo Bellazzi,
- Kelly Cho,
- Yuk-Lam Ho,
- Amelia L. M. Tan,
- Byorn W. L. Tan,
- Nils Gehlenborg,
- Sara Lozano-Zahonero,
- Vianney Jouhet,
- Luca Chiovato,
- Bruce J. Aronow,
- Emma M. S. Toh,
- Wei Gen Scott Wong,
- Sara Pizzimenti,
- Kavishwar B. Wagholikar,
- Mauro Bucalo,
- The Consortium for Clinical Characterization of COVID-19 by EHR (4CE),
- Tianxi Cai,
- Andrew M. South,
- Isaac S. Kohane,
- Griffin M. Weber
Affiliations
- Harrison G. Zhang
- Department of Biomedical Informatics, Harvard Medical School
- Arianna Dagliati
- Department of Electrical Computer and Biomedical Engineering, University of Pavia
- Zahra Shakeri Hossein Abad
- Department of Biomedical Informatics, Harvard Medical School
- Xin Xiong
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
- Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School
- Zongqi Xia
- Department of Neurology, University of Pittsburgh
- Bryce W. Q. Tan
- Department of Medicine, National University Hospital
- Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School
- Gabriel A. Brat
- Department of Biomedical Informatics, Harvard Medical School
- Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School
- Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh
- Lav P. Patel
- Department of Internal Medicine, Division of Medical Informatics, University Of Kansas Medical Center
- Alba Gutiérrez-Sacristán
- Department of Biomedical Informatics, Harvard Medical School
- David A. Hanauer
- Department of Learning Health Sciences, University of Michigan Medical School
- John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine
- Malarkodi Jebathilagam Samayamuthu
- Department of Biomedical Informatics, University of Pittsburgh
- Florence T. Bourgeois
- Department of Pediatrics, Harvard Medical School
- Sehi L’Yi
- Department of Biomedical Informatics, Harvard Medical School
- Sarah E. Maidlow
- Michigan Institute for Clinical and Health Research (MICHR) Informatics, University of Michigan
- Bertrand Moal
- IAM unit, Bordeaux University Hospital
- Shawn N. Murphy
- Department of Neurology, Massachusetts General Hospital
- Zachary H. Strasser
- Department of Medicine, Massachusetts General Hospital
- Antoine Neuraz
- Department of biomedical informatics, Hôpital Necker-Enfants Malade, Assistance Publique Hôpitaux de Paris (APHP), University of Paris
- Kee Yuan Ngiam
- Department of Biomedical informatics, WiSDM, National University Health Systems Singapore
- Ne Hooi Will Loh
- Department of Anaesthesia, National University Health Systems Singapore
- Gilbert S. Omenn
- Department of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, and School of Public Health, University of Michigan
- Andrea Prunotto
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
- Lauren A. Dalvin
- Department of Ophthalmology, Mayo Clinic
- Jeffrey G. Klann
- Department of Medicine, Massachusetts General Hospital
- Petra Schubert
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System
- Fernando J. Sanz Vidorreta
- Department of Medicine, David Geffen School of Medicine at UCLA
- Vincent Benoit
- IT Department, Innovation & Data, APHP Greater Paris University Hospital
- Guillaume Verdy
- IAM unit, Bordeaux University Hospital
- Ramakanth Kavuluru
- Division of Biomedical Informatics (Department of Internal Medicine), University of Kentucky
- Hossein Estiri
- Department of Medicine, Massachusetts General Hospital
- Yuan Luo
- Department of Preventive Medicine, Northwestern University
- Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS
- Valentina Tibollo
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS
- Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia
- Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System
- Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System
- Amelia L. M. Tan
- Department of Biomedical Informatics, Harvard Medical School
- Byorn W. L. Tan
- Department of Medicine, National University Hospital
- Nils Gehlenborg
- Department of Biomedical Informatics, Harvard Medical School
- Sara Lozano-Zahonero
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
- Vianney Jouhet
- IAM unit, INSERM Bordeaux Population Health ERIAS TEAM, Bordeaux University Hospital / ERIAS - Inserm
- Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri SpA SB IRCCS
- Bruce J. Aronow
- Departments of Biomedical Informatics, Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati
- Emma M. S. Toh
- Yong Loo Lin School of Medicine, National University of Singapore
- Wei Gen Scott Wong
- Department of Medicine, National University Health Systems Singapore
- Sara Pizzimenti
- Scientific Direction, IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano
- Kavishwar B. Wagholikar
- Department of Medicine, Massachusetts General Hospital
- Mauro Bucalo
- BIOMERIS (BIOMedical Research Informatics Solutions)
- The Consortium for Clinical Characterization of COVID-19 by EHR (4CE)
- Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School
- Andrew M. South
- Department of Pediatrics-Section of Nephrology, Brenner Children’s, Wake Forest School of Medicine
- Isaac S. Kohane
- Department of Biomedical Informatics, Harvard Medical School
- Griffin M. Weber
- Department of Biomedical Informatics, Harvard Medical School
- DOI
- https://doi.org/10.1038/s41746-022-00623-8
- Journal volume & issue
-
Vol. 5,
no. 1
pp. 1 – 11
Abstract
Abstract The risk profiles of post-acute sequelae of COVID-19 (PASC) have not been well characterized in multi-national settings with appropriate controls. We leveraged electronic health record (EHR) data from 277 international hospitals representing 414,602 patients with COVID-19, 2.3 million control patients without COVID-19 in the inpatient and outpatient settings, and over 221 million diagnosis codes to systematically identify new-onset conditions enriched among patients with COVID-19 during the post-acute period. Compared to inpatient controls, inpatient COVID-19 cases were at significant risk for angina pectoris (RR 1.30, 95% CI 1.09–1.55), heart failure (RR 1.22, 95% CI 1.10–1.35), cognitive dysfunctions (RR 1.18, 95% CI 1.07–1.31), and fatigue (RR 1.18, 95% CI 1.07–1.30). Relative to outpatient controls, outpatient COVID-19 cases were at risk for pulmonary embolism (RR 2.10, 95% CI 1.58–2.76), venous embolism (RR 1.34, 95% CI 1.17–1.54), atrial fibrillation (RR 1.30, 95% CI 1.13–1.50), type 2 diabetes (RR 1.26, 95% CI 1.16–1.36) and vitamin D deficiency (RR 1.19, 95% CI 1.09–1.30). Outpatient COVID-19 cases were also at risk for loss of smell and taste (RR 2.42, 95% CI 1.90–3.06), inflammatory neuropathy (RR 1.66, 95% CI 1.21–2.27), and cognitive dysfunction (RR 1.18, 95% CI 1.04–1.33). The incidence of post-acute cardiovascular and pulmonary conditions decreased across time among inpatient cases while the incidence of cardiovascular, digestive, and metabolic conditions increased among outpatient cases. Our study, based on a federated international network, systematically identified robust conditions associated with PASC compared to control groups, underscoring the multifaceted cardiovascular and neurological phenotype profiles of PASC.
