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Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC).
Elife. 2020 08 17; 9E

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.

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Authors+Show Affiliations

Pawlowski C
nference, inc, Cambridge, United States.
Wagner T
nference, inc, Cambridge, United States.
Puranik A
nference, inc, Cambridge, United States.
Murugadoss K
nference, inc, Cambridge, United States.
Loscalzo L
nference, inc, Cambridge, United States.
Venkatakrishnan AJ
nference, inc, Cambridge, United States.
Pruthi RK
Mayo Clinic, Rochester, United States.
Houghton DE
Mayo Clinic, Rochester, United States.
O'Horo JC
Mayo Clinic, Rochester, United States.
Morice WG
Mayo Clinic, Rochester, United States. Mayo Clinic Laboratories, Rochester, United States.
Williams AW
Mayo Clinic, Rochester, United States.
Gores GJ
Mayo Clinic, Rochester, United States.
Halamka J
Mayo Clinic, Rochester, United States. Mayo Clinic Platform, Rochester, United States.
Badley AD
Mayo Clinic, Rochester, United States.
Barnathan ES
Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States.
Makimura H
Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States.
Khan N
Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States.
Soundararajan V
nference, inc, Cambridge, United States.

MeSH

AgedBetacoronavirusBiomarkersBlood CoagulationBlood Coagulation DisordersBlood Coagulation TestsCOVID-19COVID-19 TestingClinical Laboratory TechniquesCoronavirus InfectionsDisease ProgressionFemaleFibrinogenHost Microbial InteractionsHumansLeukocyte CountLongitudinal StudiesMaleMiddle AgedPandemicsPlatelet CountPneumonia, ViralPredictive Value of TestsReproducibility of ResultsRetrospective StudiesSARS-CoV-2Time Factors

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32804081

Citation

Pawlowski, Colin, et al. "Inference From Longitudinal Laboratory Tests Characterizes Temporal Evolution of COVID-19-associated Coagulopathy (CAC)." ELife, vol. 9, 2020.
Pawlowski C, Wagner T, Puranik A, et al. Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC). Elife. 2020;9.
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. https://doi.org/10.7554/eLife.59209
Pawlowski C, et al. Inference From Longitudinal Laboratory Tests Characterizes Temporal Evolution of COVID-19-associated Coagulopathy (CAC). Elife. 2020 08 17;9 PubMed PMID: 32804081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC). AU - Pawlowski,Colin, AU - Wagner,Tyler, AU - Puranik,Arjun, AU - Murugadoss,Karthik, AU - Loscalzo,Liam, AU - Venkatakrishnan,A J, AU - Pruthi,Rajiv K, AU - Houghton,Damon E, AU - O'Horo,John C, AU - Morice,William G,2nd AU - Williams,Amy W, AU - Gores,Gregory J, AU - Halamka,John, AU - Badley,Andrew D, AU - Barnathan,Elliot S, AU - Makimura,Hideo, AU - Khan,Najat, AU - Soundararajan,Venky, Y1 - 2020/08/17/ PY - 2020/05/22/received PY - 2020/08/14/accepted PY - 2020/8/18/pubmed PY - 2020/9/17/medline PY - 2020/8/18/entrez KW - COVID-19 KW - SARS-CoV-2 KW - coagulation KW - electronic health record (EHR) KW - human KW - laboratory tests KW - medicine KW - thrombolytic agents JF - eLife JO - Elife VL - 9 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. SN - 2050-084X UR - https://www.unboundmedicine.com/medline/citation/32804081/Inference_from_longitudinal_laboratory_tests_characterizes_temporal_evolution_of_COVID_19_associated_coagulopathy__CAC__ DB - PRIME DP - Unbound Medicine ER -