Open AccessElectronic health record analysis identifies kidney disease as the leading risk factor for hospitalization in confirmed COVID-19 patients
Author(s) -
Matthew T. Oetjens,
Jonathan Z. Luo,
Alexander R. Chang,
Joseph B. Leader,
Dustin N. Hartzel,
Bryn Moore,
Natasha T. Strande,
H. Lester Kirchner,
David H. Ledbetter,
Anne E. Justice,
David J. Carey,
Tooraj Mirshahi
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0242182
Subject(s) - medicine , phenome , kidney disease , dialysis , retrospective cohort study , renal function , medical record , comorbidity , diabetes mellitus , disease , clinical significance , end stage renal disease , intensive care medicine , phenotype , endocrinology , biology , biochemistry , gene
Background Empirical data on conditions that increase risk of coronavirus disease 2019 (COVID-19) progression are needed to identify high risk individuals. We performed a comprehensive quantitative assessment of pre-existing clinical phenotypes associated with COVID-19-related hospitalization. Methods Phenome-wide association study (PheWAS) of SARS-CoV-2-positive patients from an integrated health system (Geisinger) with system-level outpatient/inpatient COVID-19 testing capacity and retrospective electronic health record (EHR) data to assess pre-COVID-19 pandemic clinical phenotypes associated with hospital admission (hospitalization). Results Of 12,971 individuals tested for SARS-CoV-2 with sufficient pre-COVID-19 pandemic EHR data at Geisinger, 1604 were SARS-CoV-2 positive and 354 required hospitalization. We identified 21 clinical phenotypes in 5 disease categories meeting phenome-wide significance (P<1.60x10 -4 ), including: six kidney phenotypes, e.g. end stage renal disease or stage 5 CKD (OR = 11.07, p = 1.96x10 -8 ), six cardiovascular phenotypes, e.g. congestive heart failure (OR = 3.8, p = 3.24x10 -5 ), five respiratory phenotypes, e.g. chronic airway obstruction (OR = 2.54, p = 3.71x10 -5 ), and three metabolic phenotypes, e.g. type 2 diabetes (OR = 1.80, p = 7.51x10 -5 ). Additional analyses defining CKD based on estimated glomerular filtration rate, confirmed high risk of hospitalization associated with pre-existing stage 4 CKD (OR 2.90, 95% CI: 1.47, 5.74), stage 5 CKD/dialysis (OR 8.83, 95% CI: 2.76, 28.27), and kidney transplant (OR 14.98, 95% CI: 2.77, 80.8) but not stage 3 CKD (OR 1.03, 95% CI: 0.71, 1.48). Conclusions This study provides quantitative estimates of the contribution of pre-existing clinical phenotypes to COVID-19 hospitalization and highlights kidney disorders as the strongest factors associated with hospitalization in an integrated US healthcare system.