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

On average, white blood cell count (WBC), a measure of immune response, was within normal limits on presentation. Patients who remained in the hospital and survived had increasing WBCs over time without severe leukocytosis. 27 Lymphocyte and neutrophil count trajectories can be seen on the website. Procalcitonin and LDH were not commonly tested in the total patient population, but results are also online. C-reactive protein (CRP), a measure of systemic inflammation, was notably elevated on presentation for all patients in the cohort with a very narrow confidence interval, consistent with previous findings. 19 Although it is of unclear importance, populations of patients who remained in the hospital, survived, and had ongoing laboratory testing showed improvements over time. Interestingly, despite a decreasing trajectory during the first week, a mild leukocytosis is observed in counterbalance during the second week. The implication may be that CRP is not predictive of ongoing hospitalization or CRP is being checked for patient populations where the laboratory is more commonly improving. D-dimer, an acute phase reactant and measure of coagulopathy, was elevated across institutions and countries at presentation. It rose consistently in all populations who continued to be hospitalized with the disease. This was consistent with multiple studies that showed a prothrombotic element to the disease. Most importantly, changes were consistent across all sites and highly abnormal.