International electronic health record-derived post-acute sequelae profiles of COVID-19 patients,npj Digital Medicine

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International electronic health record-derived post-acute sequelae profiles of COVID-19 patients
npj Digital Medicine ( IF 12.4 ) Pub Date : 2022-06-29 , DOI: 10.1038/s41746-022-00623-8
Harrison G Zhang ₁ , Arianna Dagliati ₂ , Zahra Shakeri Hossein Abad ₁ , Xin Xiong ₃ , Clara-Lea Bonzel ₁ , Zongqi Xia ₄ , Bryce W Q Tan ₅ , Paul Avillach ₁ , Gabriel A Brat ₁ , Chuan Hong _{1,

6} , Michele Morris ₇ , Shyam Visweswaran ₇ , Lav P Patel ₈ , Alba Gutiérrez-Sacristán ₁ , David A Hanauer ₉ , John H Holmes _{10,

11} , Malarkodi Jebathilagam Samayamuthu ₇ , Florence T Bourgeois ₁₂ , Sehi L'Yi ₁ , Sarah E Maidlow ₁₃ , Bertrand Moal ₁₄ , Shawn N Murphy ₁₅ , Zachary H Strasser ₁₆ , Antoine Neuraz ₁₇ , Kee Yuan Ngiam ₁₈ , Ne Hooi Will Loh ₁₉ , Gilbert S Omenn ₂₀ , Andrea Prunotto ₂₁ , Lauren A Dalvin ₂₂ , Jeffrey G Klann ₁₆ , Petra Schubert ₂₃ , Fernando J Sanz Vidorreta ₂₄ , Vincent Benoit ₂₅ , Guillaume Verdy ₁₄ , Ramakanth Kavuluru ₂₆ , Hossein Estiri ₁₆ , Yuan Luo ₂₇ , Alberto Malovini ₂₈ , Valentina Tibollo ₂₈ , Riccardo Bellazzi ₂₉ , Kelly Cho _{23,

30} , Yuk-Lam Ho ₂₃ , Amelia L M Tan ₁ , Byorn W L Tan ₅ , Nils Gehlenborg ₁ , Sara Lozano-Zahonero ₂₁ , Vianney Jouhet ₃₁ , Luca Chiovato ₃₂ , Bruce J Aronow ₃₃ , Emma M S Toh ₃₄ , Wei Gen Scott Wong ₃₅ , Sara Pizzimenti ₃₆ , Kavishwar B Wagholikar ₁₆ , Mauro Bucalo ₃₇ , , Tianxi Cai ₁ , Andrew M South ₃₈ , Isaac S Kohane ₁ , Griffin M Weber ₁

Affiliation

Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Department of Electrical Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Medicine, National University Hospital, Singapore, Singapore.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Internal Medicine, Division of Medical Informatics, University Of Kansas Medical Center, Kansas City, MO, USA.
Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Michigan Institute for Clinical and Health Research (MICHR) Informatics, University of Michigan, Ann Arbor, MI, USA.
IAM unit, Bordeaux University Hospital, Bordeaux, France.
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of biomedical informatics, Hôpital Necker-Enfants Malade, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, Paris, France.
Department of Biomedical informatics, WiSDM, National University Health Systems Singapore, Singapore, Singapore.
Department of Anaesthesia, National University Health Systems Singapore, Singapore, Singapore.
Department of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, and School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Department of Ophthalmology, Mayo Clinic, Rochester, NY, USA.
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
IT Department, Innovation & Data, APHP Greater Paris University Hospital, Paris, France.
Division of Biomedical Informatics (Department of Internal Medicine), University of Kentucky, Lexington, KY, USA.
Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy.
Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.
Population Health and Data Science, VA Boston Healthcare System, Boston, MA, USA.
IAM unit, INSERM Bordeaux Population Health ERIAS TEAM, Bordeaux University Hospital / ERIAS - Inserm, U1219 BPH, Bordeaux, France.
Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy.
Departments of Biomedical Informatics, Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Medicine, National University Health Systems Singapore, Singapore, Singapore.
Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
BIOMERIS (BIOMedical Research Informatics Solutions), Pavia, Italy.
Department of Pediatrics-Section of Nephrology, Brenner Children's, Wake Forest School of Medicine, Winston Salem, NC, USA.

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.

中文翻译：

国际电子健康记录衍生的 COVID-19 患者急性后遗症概况

COVID-19 后急性后遗症 (PASC) 的风险概况在具有适当控制措施的多国环境中尚未得到很好的表征。我们利用来自 277 家国际医院的电子健康记录 (EHR) 数据，这些医院代表 414,602 名 COVID-19 患者、230 万住院和门诊非 COVID-19 对照患者以及超过 2.21 亿个诊断代码，以系统地识别新发疾病在急性期后的 COVID-19 患者中。与住院患者对照相比，住院 COVID-19 病例发生心绞痛 (RR 1.30, 95% CI 1.09–1.55)、心力衰竭 (RR 1.22, 95% CI 1.10–1.35)、认知功能障碍 (RR 1.18, 95) 的风险显着% CI 1.07–1.31）和疲劳（RR 1.18，95% CI 1.07–1.30）。相对于门诊控制，门诊 COVID-19 病例存在肺栓塞（RR 2.10，95% CI 1.58-2.76）、静脉栓塞（RR 1.34，95% CI 1.17-1.54）、房颤（RR 1.30，95% CI 1.13-1.50）的风险、2 型糖尿病（RR 1.26，95% CI 1.16–1.36）和维生素 D 缺乏症（RR 1.19，95% CI 1.09–1.30）。门诊 COVID-19 病例也存在嗅觉和味觉丧失（RR 2.42，95% CI 1.90-3.06）、炎症性神经病变（RR 1.66，95% CI 1.21-2.27）和认知功能障碍（RR 1.18，95%）的风险置信区间 1.04–1.33）。住院病例中急性后心血管和肺部疾病的发病率随时间下降，而门诊病例中心血管、消化和代谢疾病的发病率增加。我们的研究基于联合国际网络，

更新日期：2022-06-29

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