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Journal Articles Journal of Medical Internet Research Year : 2021

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

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Griffin Weber
Harrison Zhang
Sehi L'Yi
Clara-Lea Bonzel
Chuan Hong
Paul Avillach
Alba Gutiérrez-Sacristán
Nathan Palmer
Amelia Li Min Tan
Xuan Wang
William Yuan
Nils Gehlenborg
Anna Alloni
Danilo Amendola
Antonio Bellasi
Riccardo Bellazzi
Michele Beraghi
Mauro Bucalo
Luca Chiovato
Kelly Cho
Arianna Dagliati
Hossein Estiri
Robert Follett
Noelia García Barrio
David Hanauer
Darren Henderson
Yuk-Lam Ho
John Holmes
Meghan Hutch
Ramakanth Kavuluru
Katie Kirchoff
Jeffrey Klann
Ashok Krishnamurthy
Trang Le
Molei Liu
Ne Hooi Will Loh
Sara Lozano-Zahonero
Yuan Luo
Sarah Maidlow
Adeline Makoudjou
Alberto Malovini
Marcelo Roberto Martins
Bertrand Moal
Michele Morris
Danielle Mowery
Shawn Murphy
Kee Yuan Ngiam
Marina Okoshi
Gilbert Omenn
Lav Patel
Miguel Pedrera Jiménez
Robson Prudente
Malarkodi Jebathilagam Samayamuthu
Fernando Sanz Vidorreta
Emily Schriver
Petra Schubert
Pablo Serrano Balazote
Byorn Wl Tan
Suzana Tanni
Valentina Tibollo
Shyam Visweswaran
Kavishwar Wagholikar
Zongqi Xia
Daniela Zöller
Isaac Kohane
Tianxi Cai
Andrew South
Gabriel Brat

Abstract

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

Dates and versions

hal-03476723 , version 1 (13-12-2021)

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Griffin Weber, Harrison Zhang, Sehi L'Yi, Clara-Lea Bonzel, Chuan Hong, et al.. International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study. Journal of Medical Internet Research, 2021, 23 (10), pp.e31400. ⟨10.2196/31400⟩. ⟨hal-03476723⟩
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