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Title: International electronic health record-derived post-acute sequelae profiles of COVID-19 patients
Authors: Zhang, Harrison G
Dagliati, Arianna
Abad, Zahra Shakeri Hossein
Xiong, Xin
Bonzel, Clara-Lea
Xia, Zongqi
Tan, Bryce WQ
Avillach, Paul
Brat, Gabriel A
Hong, Chuan
Morris, Michele
Visweswaran, Shyam
Patel, Lav P
Gutierrez-Sacristan, Alba
Hanauer, David A
Holmes, John H
Samayamuthu, Malarkodi Jebathilagam
Bourgeois, Florence T
L'Yi, Sehi
Maidlow, Sarah E
Moal, Bertrand
Murphy, Shawn N
Strasser, Zachary H
Neuraz, Antoine
Ngiam, Kee Yuan 
Loh, Ne Hooi Will 
Omenn, Gilbert S
Prunotto, Andrea
Dalvin, Lauren A
Klann, Jeffrey G
Schubert, Petra
Vidorreta, Fernando J Sanz
Benoit, Vincent
Verdy, Guillaume
Kavuluru, Ramakanth
Estiri, Hossein
Luo, Yuan
Malovini, Alberto
Tibollo, Valentina
Bellazzi, Riccardo
Cho, Kelly
Ho, Yuk-Lam
Tan, Amelia LM
Tan, Byorn WL
Gehlenborg, Nils
Lozano-Zahonero, Sara
Jouhet, Vianney
Chiovato, Luca
Aronow, Bruce J
Toh, Emma MS
Wong, Wei Gen Scott
Pizzimenti, Sara
Wagholikar, Kavishwar B
Bucalo, Mauro
Cai, Tianxi
South, Andrew M
Kohane, Isaac S
Weber, Griffin M
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Medical Informatics
Issue Date: 29-Jun-2022
Citation: Zhang, Harrison G, Dagliati, Arianna, Abad, Zahra Shakeri Hossein, Xiong, Xin, Bonzel, Clara-Lea, Xia, Zongqi, Tan, Bryce WQ, Avillach, Paul, Brat, Gabriel A, Hong, Chuan, Morris, Michele, Visweswaran, Shyam, Patel, Lav P, Gutierrez-Sacristan, Alba, Hanauer, David A, Holmes, John H, Samayamuthu, Malarkodi Jebathilagam, Bourgeois, Florence T, L'Yi, Sehi, Maidlow, Sarah E, Moal, Bertrand, Murphy, Shawn N, Strasser, Zachary H, Neuraz, Antoine, Ngiam, Kee Yuan, Loh, Ne Hooi Will, Omenn, Gilbert S, Prunotto, Andrea, Dalvin, Lauren A, Klann, Jeffrey G, Schubert, Petra, Vidorreta, Fernando J Sanz, Benoit, Vincent, Verdy, Guillaume, Kavuluru, Ramakanth, Estiri, Hossein, Luo, Yuan, Malovini, Alberto, Tibollo, Valentina, Bellazzi, Riccardo, Cho, Kelly, Ho, Yuk-Lam, Tan, Amelia LM, Tan, Byorn WL, Gehlenborg, Nils, Lozano-Zahonero, Sara, Jouhet, Vianney, Chiovato, Luca, Aronow, Bruce J, Toh, Emma MS, Wong, Wei Gen Scott, Pizzimenti, Sara, Wagholikar, Kavishwar B, Bucalo, Mauro, Cai, Tianxi, South, Andrew M, Kohane, Isaac S, Weber, Griffin M (2022-06-29). International electronic health record-derived post-acute sequelae profiles of COVID-19 patients. NPJ DIGITAL MEDICINE 5 (1). ScholarBank@NUS Repository.
Abstract: The risk profiles of post-acute sequelae of COVID-19 (PASC) have not been well characterized in multi-national settings with appropriate controls. We leveraged electronic health record (EHR) data from 277 international hospitals representing 414,602 patients with COVID-19, 2.3 million control patients without COVID-19 in the inpatient and outpatient settings, and over 221 million diagnosis codes to systematically identify new-onset conditions enriched among patients with COVID-19 during the post-acute period. Compared to inpatient controls, inpatient COVID-19 cases were at significant risk for angina pectoris (RR 1.30, 95% CI 1.09–1.55), heart failure (RR 1.22, 95% CI 1.10–1.35), cognitive dysfunctions (RR 1.18, 95% CI 1.07–1.31), and fatigue (RR 1.18, 95% CI 1.07–1.30). Relative to outpatient controls, outpatient COVID-19 cases were at risk for pulmonary embolism (RR 2.10, 95% CI 1.58–2.76), venous embolism (RR 1.34, 95% CI 1.17–1.54), atrial fibrillation (RR 1.30, 95% CI 1.13–1.50), type 2 diabetes (RR 1.26, 95% CI 1.16–1.36) and vitamin D deficiency (RR 1.19, 95% CI 1.09–1.30). Outpatient COVID-19 cases were also at risk for loss of smell and taste (RR 2.42, 95% CI 1.90–3.06), inflammatory neuropathy (RR 1.66, 95% CI 1.21–2.27), and cognitive dysfunction (RR 1.18, 95% CI 1.04–1.33). The incidence of post-acute cardiovascular and pulmonary conditions decreased across time among inpatient cases while the incidence of cardiovascular, digestive, and metabolic conditions increased among outpatient cases. Our study, based on a federated international network, systematically identified robust conditions associated with PASC compared to control groups, underscoring the multifaceted cardiovascular and neurological phenotype profiles of PASC.
ISSN: 2398-6352
DOI: 10.1038/s41746-022-00623-8
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