International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study

• DOI: 10.2196/31400
• Publication Date: 2021-09-03T01:51:26Z
• Authors: Griffin M Weber; Harrison G Zhang; Sehi L'Yi; Clara-Lea Bonzel; Chuan Hong; Paul Avillach; Alba Gutiérrez-Sa...; Nathan P Palmer; Amelia Li Min Tan; Xuan Wang; William Yuan; Nils Gehlenborg; Anna Alloni; Danilo F Amendola; Antonio Bellasi; Riccardo Bellazzi; Michele Beraghi; Mauro Bucalo; Luca Chiovato; Kelly Cho; Arianna Dagliati; Hossein Estiri; Robert W Follett; Noelia García Barrio; David A Hanauer; Darren W Henderson; Yuk-Lam Ho; John H Holmes; Meghan R Hutch; Ramakanth Kavuluru; Katie Kirchoff; Jeffrey G Klann; Ashok K Krishnamu...; Trang T Le; Molei Liu; Ne Hooi Will Loh; Sara Lozano-Zahonero; Yuan Luo; Sarah Maidlow; Adeline Makoudjou; Alberto Malovini; Marcelo Roberto M...; Bertrand Moal; Michele Morris; Danielle L Mowery; Shawn N Murphy; Antoine Neuraz; Kee Yuan Ngiam; Marina P Okoshi; Gilbert S Omenn; Lav P Patel; Miguel Pedrera Ji...; Robson A Prudente; Malarkodi Jebathi...; Fernando J Sanz V...; Emily R Schriver; Petra Schubert; Pablo Serrano Bal...; Byorn WL Tan; Suzana E Tanni; Valentina Tibollo; Shyam Visweswaran; Kavishwar B Wagho...; Zongqi Xia; Daniela Zöller; ; Isaac S Kohane; Tianxi Cai; Andrew M South; Gabriel A Brat
• Keywords: Procalcitonin; Pandemic

Many countries have experienced 2 predominant waves of COVID-19-related hospitalizations. Comparing the clinical trajectories patients hospitalized in separate pandemic enables further understanding evolving epidemiology, pathophysiology, and health care dynamics COVID-19 pandemic. In this retrospective cohort study, we analyzed electronic record (EHR) data from with SARS-CoV-2 infections participating systems representing 315 hospitals across 6 countries. We compared hospitalization rates, severe risk, mean laboratory values between during first second Using a federated approach, each system extracted patient-level on their wave cohorts submitted aggregated to central site. Data quality control steps were adopted at site correct for implausible harmonize units. Statistical analyses performed by computing individual effect sizes synthesizing these using random meta-analyses account heterogeneity. focused analysis C-reactive protein (CRP), ferritin, fibrinogen, procalcitonin, D-dimer, creatinine based reported associations COVID-19. available 79,613 patients, which 32,467 47,146 wave. The prevalence male aged 50 69 years decreased significantly waves. Patients had 9.9% reduction risk (95% CI 8.5%-11.3%). Demographic subgroup indicated that 26 49 years; female patients; black lower disease than At admission, CRP On seventh hospital day, CRP, procalcitonin general, exhibited variable changes testing rates there was higher rate D-dimer France, Germany, Spain. This corresponded more likely be typical physiological ranges day Our approach demonstrated feasibility power harmonizing heterogeneous EHR multiple international rapidly conduct large-scale studies characterize how evolve.