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Temporal inference from laboratory testing results and their triangulationwith clinical outcomes as described in the associated unstructured text fromthe providers notes in the Electronic Health Record (EHR) is integral toadvancing precision medicine. Here, we studied 181 COVIDpos and 7,775 COVIDnegpatients subjected to 1.3 million laboratory tests across 194 assays during atwo-month observation period centered around their SARS-CoV-2 PCR testingdates. We found that compared to COVIDneg at the time of clinical presentationand diagnostic testing, COVIDpos patients tended to have higher plasmafibrinogen levels and similarly low platelet counts, with approximately 25% ofpatients in both cohorts showing outright thrombocytopenia. However, thesemeasures show opposite longitudinal trends as the infection evolves, withdeclining fibrinogen and increasing platelet counts to levels that are lowerand higher compared to the COVIDneg cohort, respectively. Our EHR augmentedcuration efforts suggest a minority of patients develop thromboembolic eventsafter the PCR testing date, including rare cases with disseminatedintravascular coagulopathy (DIC), with most patients lacking the plateletreductions typically observed in consumptive coagulopathies. These temporaltrends present, for the first time, fine-grained resolution of COVID-19associated coagulopathy (CAC), via a digital framework that synthesizeslongitudinal lab measurements with structured medication data and neuralnetwork-powered extraction of outcomes from the unstructured EHR. This studydemonstrates how a precision medicine platform can help contextualize eachpatients specific coagulation profile over time, towards the goal of informingbetter personalization of thromboprophylaxis regimen.

Longitudinal laboratory testing tied to PCR diagnostics in COVID-19 patients reveals temporal evolution of distinctive coagulopathy signatures