nference

Longitudinal laboratory testing tied to PCR diagnostics in COVID-19 patients reveals temporal evolution of distinctive coagulopathy signatures

Abstract: Temporal inference from laboratory testing results and their triangulation with clinical outcomes as described in the associated unstructured text from the provider notes in the Electronic Health Record (EHR) is integral to advancing precision medicine. Here, we studied 181 COVIDpos and 7,775 COVIDneg patients subjected to 1.3 million laboratory tests across 194 assays during a two-month observation period centered around their SARS-CoV-2 PCR testing dates. We found that compared to COVIDneg at the time of clinical presentation and diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and similarly low platelet counts, with approximately 25% of patients in both cohorts showing outright thrombocytopenia. However, these measures show opposite longitudinal trends as the infection evolves, with declining fibrinogen and increasing platelet counts to levels that are lower and higher compared to the COVIDneg cohort, respectively. Our EHR augmented curation efforts suggest a minority of patients develop thromboembolic events after the PCR testing date, including rare cases with disseminated intravascular coagulopathy (DIC), with most patients lacking the platelet reductions typically observed in consumptive coagulopathies. These temporal trends present, for the first time, fine-grained resolution of COVID-19 associated coagulopathy (CAC), via a digital framework that synthesizes longitudinal lab measurements with structured medication data and neural network-powered extraction of outcomes from the unstructured EHR. This study demonstrates how a precision medicine platform can help contextualize each patients specific coagulation profile over time, towards the goal of informing better personalization of thromboprophylaxis regimen.
  • Aggregate results from 5 selected lab tests for COVIDpos and COVIDneg (matched) patient cohorts over a 60-day period centered around the PCR diagnostic testing date (day 0).
  • Authors:
  • Colin Pawlowski1,
  • Tyler Wagner1,
  • Arjun Puranik1,
  • Karthik Murugadoss1,
  • Liam Loscalzo1,
  • Rajiv K. Pruthi2,
  • John C. O’Horo2,
  • William G. Morice II2,3,
  • John Halamka2,
  • Andrew D. Badley2,
  • Elliot S. Barnathan4,
  • Hideo Makimura4,
  • Najat Khan4,
  • Venky Soundararajan1
  • 1nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
  • 2Mayo Clinic, Rochester MN, USA
  • 2Mayo Clinic Laboratories, Rochester MN, USA
  • 4Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, PA, USA
  • Affiliations:
  • Copyright:
  • The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
  • Media coverage:
  • Affiliations:
  • Media coverage:
  • Copyright:
  • The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
  • Related Tweets:
Scroll to Top