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International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study
Author(s) -
Griffin M Weber,
Harrison G. Zhang,
Sehi L’Yi,
Clara-Lea Bonzel,
Chuan Hong,
Paul Avillach,
Alba Gutiérrez-Sacristán,
Nathan Palmer,
Byorn W.L. Tan,
Xuan Wang,
Wei 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,
YukLam Ho,
John H. Holmes,
Meghan R. Hutch,
Ramakanth Kavuluru,
Katie Kirchoff,
Jeffrey G. Klann,
Ashok Krishnamurthy,
Trang T. Le,
Molei Liu,
Ne-Hooi Will Loh,
Sara LozanoZahonero,
Yuan Luo,
Sarah E. Maidlow,
Adeline Makoudjou,
Alberto Malovini,
Marcelo Roberto Martins,
Bertrand Moal,
Michele Morris,
Danielle L. Mowery,
Shawn N. Murphy,
Antoine Neuraz,
Kee Yuan Ngiam,
Marina Politi Okoshi,
Gilbert S. Omenn,
Lav P. Patel,
Miguel Pedrera-Jiménez,
Robson Prudente,
Malarkodi Jebathilagam Samayamuthu,
Fernando J Sanz Vidorreta,
Emily Schriver,
Petra Schubert,
Pablo Serrano Balazote,
Byorn W.L. Tan,
Suzana Erico Tanni,
Valentina Tibollo,
Shyam Visweswaran,
Kavishwar B. Wagholikar,
Zongqi Xia,
Daniela Zöller,
Isaac S. Kohane,
Tianxi Cai,
Andrew M. South,
Gabriel Brat
Publication year - 2021
Publication title -
jmir. journal of medical internet research/journal of medical internet research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.446
H-Index - 142
eISSN - 1439-4456
pISSN - 1438-8871
DOI - 10.2196/31400
Subject(s) - medicine , retrospective cohort study , procalcitonin , epidemiology , pandemic , cohort , health care , cohort study , emergency medicine , intensive care medicine , pediatrics , covid-19 , disease , sepsis , infectious disease (medical specialty) , economics , economic growth
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.

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