Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC)

Colin Pawlowski; Tyler Wagner; Arjun Puranik; Karthik Murugadoss; Liam Loscalzo; A. J. Venkatakrishnan; Rajiv K. Pruthi; Damon E. Houghton; John C. O’horo; William G. Morice; Amy W. Williams; Gregory J. Gores; John Halamka; Andrew D. Badley; Elliot S. Barnathan; Hideo Makimura; Najat Khan; Venky Soundararajan

doi:10.7554/ELIFE.59209

Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC)

Colin Pawlowski, Tyler Wagner, Arjun Puranik, Karthik Murugadoss, Liam Loscalzo, A. J. Venkatakrishnan, Rajiv K. Pruthi, Damon E. Houghton, John C. O’horo, William G. Morice, Amy W. Williams, Gregory J. Gores, John Halamka, Andrew D. Badley, Elliot S. Barnathan, Hideo Makimura, Najat Khan, Venky Soundararajan

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVID_pos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVID_neg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVID_neg patients at the time of diagnostic testing, COVID_pos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVID_pos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVID_pos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.

Original language	English (US)
Article number	e59209
Pages (from-to)	1-28
Number of pages	28
Journal	eLife
Volume	9
DOIs	https://doi.org/10.7554/ELIFE.59209
State	Published - Aug 2020

ASJC Scopus subject areas

General Neuroscience
General Biochemistry, Genetics and Molecular Biology
General Immunology and Microbiology

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10.7554/ELIFE.59209

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Pawlowski, C., Wagner, T., Puranik, A., Murugadoss, K., Loscalzo, L., Venkatakrishnan, A. J., Pruthi, R. K., Houghton, D. E., O’horo, J. C., Morice, W. G., Williams, A. W., Gores, G. J., Halamka, J., Badley, A. D., Barnathan, E. S., Makimura, H., Khan, N., & Soundararajan, V. (2020). Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC). eLife, 9, 1-28. Article e59209. https://doi.org/10.7554/ELIFE.59209

Pawlowski, C, Wagner, T, Puranik, A, Murugadoss, K, Loscalzo, L, Venkatakrishnan, AJ, Pruthi, RK, Houghton, DE, O’horo, JC, Morice, WG, Williams, AW, Gores, GJ, Halamka, J, Badley, AD, Barnathan, ES, Makimura, H, Khan, N & Soundararajan, V 2020, 'Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC)', eLife, vol. 9, e59209, pp. 1-28. https://doi.org/10.7554/ELIFE.59209

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abstract = "Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVIDpos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVIDneg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVIDneg patients at the time of diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVIDpos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVIDpos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.",

author = "Colin Pawlowski and Tyler Wagner and Arjun Puranik and Karthik Murugadoss and Liam Loscalzo and Venkatakrishnan, {A. J.} and Pruthi, {Rajiv K.} and Houghton, {Damon E.} and O{\textquoteright}horo, {John C.} and Morice, {William G.} and Williams, {Amy W.} and Gores, {Gregory J.} and John Halamka and Badley, {Andrew D.} and Barnathan, {Elliot S.} and Hideo Makimura and Najat Khan and Venky Soundararajan",

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AU - Venkatakrishnan, A. J.

AU - Pruthi, Rajiv K.

AU - Houghton, Damon E.

AU - O’horo, John C.

AU - Morice, William G.

AU - Williams, Amy W.

AU - Gores, Gregory J.

AU - Halamka, John

AU - Badley, Andrew D.

AU - Barnathan, Elliot S.

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AU - Soundararajan, Venky

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N2 - Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVIDpos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVIDneg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVIDneg patients at the time of diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVIDpos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVIDpos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.

AB - Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVIDpos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVIDneg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVIDneg patients at the time of diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVIDpos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVIDpos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.

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Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC)

Abstract

ASJC Scopus subject areas

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