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International electronic health record-derived post-acute sequelae profiles of COVID-19 patients
Harrison G Zhang1, Arianna Dagliati2, Zahra Shakeri Hossein Abad1
1Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Insights
Post-acute sequelae of COVID-19 (PASC) present diverse cardiovascular and neurological risks. This large international study identified new-onset conditions in COVID-19 survivors, highlighting PASC
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Post-acute sequelae of COVID-19 (PASC) risk profiles remain incompletely understood globally.
- Large-scale, multi-national studies with appropriate controls are needed to characterize PASC.
- Electronic Health Record (EHR) data offers a valuable resource for studying long-term COVID-19 effects.
Purpose of the Study:
- To systematically identify new-onset conditions associated with COVID-19 in the post-acute period.
- To characterize the cardiovascular, neurological, and metabolic risk profiles of PASC.
- To compare PASC incidence across inpatient and outpatient COVID-19 cohorts.
Main Methods:
- Leveraged EHR data from 277 international hospitals.
- Analyzed data from 414,602 COVID-19 patients and 2.3 million controls.
- Utilized over 221 million diagnosis codes to identify enriched conditions post-COVID-19.
Main Results:
- Inpatient COVID-19 cases showed increased risk for angina pectoris, heart failure, cognitive dysfunction, and fatigue.
- Outpatient COVID-19 cases faced higher risks of pulmonary embolism, venous embolism, atrial fibrillation, type 2 diabetes, and vitamin D deficiency.
- Outpatient cases also experienced increased risks for loss of smell/taste, inflammatory neuropathy, and cognitive dysfunction.
Conclusions:
- PASC is associated with significant cardiovascular and neurological sequelae.
- The study identified distinct risk profiles for inpatient and outpatient COVID-19 survivors.
- Findings underscore the multifaceted nature of PASC, impacting multiple organ systems.
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.
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