Mapping each pre-existing conditions association to short-term and long-term COVID-19 complications

Venkatakrishnan, A.; Pawlowski, C.; Zemmour, D.; Hughes, T.; Anand, A.; Berner, G.; Kayal, N.; Puranik, A.; Conrad, I.; Bade, S.; Barve, R.; Sinha, P.; O'Horo, J.; Badley, A. D.; Soundararajan, V.

Understanding the relationships between pre-existing conditions and complications of COVID-19 infection is critical to identifying which patients will develop more severe disease. Here, we leverage 1.1 million clinical notes from 1,903 hospitalized COVID-19 patients and deep neural network models to characterize associations between 21 pre-existing conditions and the development of 19 complications (e.g. respiratory, cardiovascular, renal, and hematologic) of COVID-19 infection throughout the course of infection (i.e. 0-30 days, 31-60 days, and 61-90 days). Pleural effusion was the most frequent complication of early COVID-19 infection (23% of 383 complications) followed by cardiac arrhythmia (12% of 383 complications). Notably, hypertension was the most significant risk factor associated with 10 different complications including acute respiratory distress syndrome, cardiac arrhythmia and anemia. Furthermore, novel associations such as between cancer (risk ratio: 3, p=0.02) or immunosuppression (risk ratio: 4.3, p=0.04) with early-onset heart failure have also been identified. Onset of new complications after 30 days is rare and most commonly involves pleural effusion (31-60 days: 24% of 45 patients, 61-90 days: 25% of 36 patients). Overall, the associations between pre-COVID conditions and COVID-associated complications presented here may form the basis for the development of risk assessment scores to guide clinical care pathways.