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

Laboratory values reflected relatively moderate disease severity on presentation. Initial laboratory values were abnormal for all patients but were not indicative of organ failure. Major abnormal elevations were noted in C-reactive protein (CRP) and D-dimer on the day of diagnosis. As the number of days from diagnosis progressed, remaining patients who were not discharged or died had, on average, worse values. For nearly all 14 tests, trends toward progressively abnormal values were consistent with worsening disease as inpatient stays continued. Most importantly, the initial values and trajectories were highly consistent with previous findings in studies from China. 19, 27 Creatinine, a measure of renal function and the most commonly performed laboratory test in our data set, was divergent over time across sites. Rising creatinine would be consistent with an increased proportion of ill patients with significant acute kidney injury over time. Hospitals in Italy, in contrast, did not see a dramatic rise in creatinine in their hospitalized population, while the small percentage of French and German patients remaining in the hospital for two weeks had clear signs of acute kidney injury. This may represent many underlying differences including a high mortality near the beginning of the hospitalization at Italian hospitals, severe right time censoring of remaining patients, or a difference in practice.