International Electronic Health Record-Derived COVID-19 Clinical Course Profile: The 4CE Consortium

Gabriel A Brat; Griffin M Weber; Nils Gehlenborg; Paul Avillach; Nathan P Palmer; Luca Chiovato; James Cimino; Lemuel R Waitman; Gilbert S Omenn; Alberto Malovini; Jason H Moore; Brett K Beaulieu-Jones; Valentina Tibollo; Shawn N Murphy; Sehi L'Yi; Mark S Keller; Riccardo Bellazzi; David A Hanauer; Arnaud Serret-Larmande; Alba Gutierrez-Sacristan; John J Holmes; Douglas S Bell; Kenneth D Mandl; Robert W Follett; Jeffrey G Klann; Douglas A Murad; Luigia Scudeller; Mauro Bucalo; Katie Kirchoff; Jean Craig; Jihad Obeid; Vianney Jouhet; Romain Griffier; Sebastien Cossin; Bertrand Moal; Lav P Patel; Antonio Bellasi; Hans U Prokosch; Detlef Kraska; Piotr Sliz; Amelia LM Tan; Kee Yuan Ngiam; Alberto Zambelli; Danielle L Mowery; Emily Schiver; Batsal Devkota; Robert L Bradford; Mohamad Daniar; Christel Daniel; Vincent Benoit; Romain Bey; Nicolas Paris; Patricia Serre; Nina Orlova; Julien Dubiel; Martin Hilka; Anne Sophie Jannot; Stephane Breant; Judith Leblanc; Nicolas Griffon; Anita Burgun; Melodie Bernaux; Arnaud Sandrin; Elisa Salamanca; Thomas Ganslandt; Tobias Gradinger; Julien Champ; Martin Boeker; Patricia Martel; Alexandre Gramfort; Olivier Grisel; Damien Leprovost; Thomas Moreau; Gael Varoquaux; Jill Jen Vie; Demian Wassermann; Arthur Mensch; Charlotte Caucheteux; Christian Haverkamp; Guillaume Lemaitre; Christian Haverkamp; Tianxi Cai; Isaac S Kohane

The Coronavirus Disease 2019 (COVID- 19) pandemic has caught the world off guard, reshaping ways of life, the economy, and healthcare delivery all over the globe. The virulence and transmissibility of responsible virus (SARS-CoV-2) is striking. Crucially, there remains a paucity of relevant clinical information to drive response at the clinical and population levels. Even in an information technology-dominated era, fundamental measurements to guide public health decision-making remain unclear. Knowledge still lags on incidence, prevalence, case-fatality rates, and clinical predictors of disease severity and outcomes. While some of the knowledge gaps relate to the need for further laboratory testing, data that should be widely available in electronic health records have not yet been effectively shared across clinical sites, with public health agencies, or with policy makers. At the time of this writing, more than three months after the earliest reports of the disease in China, only 5.8% of US cases reported to the CDC have clinical details included. 1 Even before therapeutic trials are implemented, frontline clinicians are not yet benefitting from knowledge as basic as understanding the differences in the clinical course between male and female patients. 2 Through case studies and series, we have learned that COVID-19 can have multi-organ involvement. A growing literature has identified key markers of cardiac, 3 immune, 4 coagulation, 5 muscle, 5,6 hepatic, 7 and renal 8 injury and dysfunction, including extensive evidence of myocarditis and cardiac injury associated with severe disease. Laboratory perturbations in lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin 9 have been described. However, data from larger cohorts, linked to outcomes, remain unavailable.