International changes in COVID-19 clinical trajectories across 315 hospitals and 6 countries: Retrospective cohort study

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Autor(es): dc.contributorHarvard Medical School-
Autor(es): dc.contributorBIOMERIS (BIOMedical Research Informatics Solutions)-
Autor(es): dc.contributorUniversidade Estadual Paulista (UNESP)-
Autor(es): dc.contributorEnte Ospedaliero Cantonale-
Autor(es): dc.contributorUniversity of Pavia-
Autor(es): dc.contributorAzienda Socio-Sanitaria Territoriale di Pavia-
Autor(es): dc.contributorIstituti Clinici Scientifici Maugeri SpA SB IRCCS-
Autor(es): dc.contributorVeterans Affairs Boston Healthcare System-
Autor(es): dc.contributorMassachusetts General Hospital-
Autor(es): dc.contributorLos Angeles-
Autor(es): dc.contributorHospital Universitario 12 de Octubre-
Autor(es): dc.contributorUniversity of Michigan Medical School-
Autor(es): dc.contributorUniversity of Kentucky-
Autor(es): dc.contributorUniversity of Pennsylvania Perelman School of Medicine-
Autor(es): dc.contributorNorthwestern University-
Autor(es): dc.contributorMedical University of South Carolina-
Autor(es): dc.contributorUniversity of North Carolina at Chapel Hill-
Autor(es): dc.contributorHarvard T.H. Chan School of Public Health-
Autor(es): dc.contributorNational University Health System-
Autor(es): dc.contributorUniversity of Freiburg-
Autor(es): dc.contributorUniversity of Michigan-
Autor(es): dc.contributorBordeaux University Hospital-
Autor(es): dc.contributorUniversity of Pittsburgh-
Autor(es): dc.contributorUniversity of Paris-
Autor(es): dc.contributorUniversity of Kansas Medical Center-
Autor(es): dc.contributorUniversity of Pennsylvania Health System-
Autor(es): dc.contributorWake Forest School of Medicine-
Autor(es): dc.creatorWeber, Griffin M.-
Autor(es): dc.creatorZhang, Harrison G.-
Autor(es): dc.creatorL'Yi, Sehi-
Autor(es): dc.creatorBonzel, Clara-Lea-
Autor(es): dc.creatorHong, Chuan-
Autor(es): dc.creatorAvillach, Paul-
Autor(es): dc.creatorGutiérrez-Sacristán, Alba-
Autor(es): dc.creatorPalmer, Nathan P.-
Autor(es): dc.creatorTan, Amelia Li Min-
Autor(es): dc.creatorWang, Xuan-
Autor(es): dc.creatorYuan, William-
Autor(es): dc.creatorGehlenborg, Nils-
Autor(es): dc.creatorAlloni, Anna-
Autor(es): dc.creatorAmendola, Danilo F.-
Autor(es): dc.creatorBellasi, Antonio-
Autor(es): dc.creatorBellazzi, Riccardo-
Autor(es): dc.creatorBeraghi, Michele-
Autor(es): dc.creatorBucalo, Mauro-
Autor(es): dc.creatorChiovato, Luca-
Autor(es): dc.creatorCho, Kelly-
Autor(es): dc.creatorDagliati, Arianna-
Autor(es): dc.creatorEstiri, Hossein-
Autor(es): dc.creatorFollett, Robert W.-
Autor(es): dc.creatorBarrio, Noelia García-
Autor(es): dc.creatorHanauer, David A.-
Autor(es): dc.creatorHenderson, Darren W.-
Autor(es): dc.creatorHo, Yuk-Lam-
Autor(es): dc.creatorHolmes, John H.-
Autor(es): dc.creatorHutch, Meghan R.-
Autor(es): dc.creatorKavuluru, Ramakanth-
Autor(es): dc.creatorKirchoff, Katie-
Autor(es): dc.creatorKlann, Jeffrey G.-
Autor(es): dc.creatorKrishnamurthy, Ashok K.-
Autor(es): dc.creatorLe, Trang T.-
Autor(es): dc.creatorLiu, Molei-
Autor(es): dc.creatorLoh, Ne Hooi Will-
Autor(es): dc.creatorLozano-Zahonero, Sara-
Autor(es): dc.creatorLuo, Yuan-
Autor(es): dc.creatorMaidlow, Sarah-
Autor(es): dc.creatorMakoudjou, Adeline-
Autor(es): dc.creatorMalovini, Alberto-
Autor(es): dc.creatorMartins, Marcelo Roberto-
Autor(es): dc.creatorMoal, Bertrand-
Autor(es): dc.creatorMorris, Michele-
Autor(es): dc.creatorMowery, Danielle L.-
Autor(es): dc.creatorMurphy, Shawn N.-
Autor(es): dc.creatorNeuraz, Antoine-
Autor(es): dc.creatorNgiam, Kee Yuan-
Autor(es): dc.creatorOkoshi, Marina P.-
Autor(es): dc.creatorOmenn, Gilbert S.-
Autor(es): dc.creatorPatel, Lav P.-
Autor(es): dc.creatorJiménez, Miguel Pedrera-
Autor(es): dc.creatorPrudente, Robson A.-
Autor(es): dc.creatorSamayamuthu, Malarkodi Jebathilagam-
Autor(es): dc.creatorSanz Vidorreta, Fernando J.-
Autor(es): dc.creatorSchriver, Emily R.-
Autor(es): dc.creatorSchubert, Petra-
Autor(es): dc.creatorBalazote, Pablo Serrano-
Autor(es): dc.creatorTan, Byorn W.L.-
Autor(es): dc.creatorTanni, Suzana E.-
Autor(es): dc.creatorTibollo, Valentina-
Autor(es): dc.creatorVisweswaran, Shyam-
Autor(es): dc.creatorWagholikar, Kavishwar B.-
Autor(es): dc.creatorXia, Zongqi-
Autor(es): dc.creatorZöller, Daniela-
Autor(es): dc.creatorKohane, Isaac S.-
Autor(es): dc.creatorCai, Tianxi-
Autor(es): dc.creatorSouth, Andrew M.-
Autor(es): dc.creatorBrat, Gabriel A.-
Data de aceite: dc.date.accessioned2025-08-21T16:35:42Z-
Data de disponibilização: dc.date.available2025-08-21T16:35:42Z-
Data de envio: dc.date.issued2022-04-29-
Data de envio: dc.date.issued2022-04-29-
Data de envio: dc.date.issued2021-10-01-
Fonte completa do material: dc.identifierhttp://dx.doi.org/10.2196/31400-
Fonte completa do material: dc.identifierhttp://hdl.handle.net/11449/229709-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/11449/229709-
Descrição: dc.descriptionBackground: Many countries have experienced 2 predominant waves of COVID-19–related hospitalizations. Comparing the clinical trajectories of patients hospitalized in separate waves of the pandemic enables further understanding of the evolving epidemiology, pathophysiology, and health care dynamics of the COVID-19 pandemic. Objective: In this retrospective cohort study, we analyzed electronic health record (EHR) data from patients with SARS-CoV-2 infections hospitalized in participating health care systems representing 315 hospitals across 6 countries. We compared hospitalization rates, severe COVID-19 risk, and mean laboratory values between patients hospitalized during the first and second waves of the pandemic. Methods: Using a federated approach, each participating health care system extracted patient-level clinical data on their first and second wave cohorts and submitted aggregated data to the central site. Data quality control steps were adopted at the central site to correct for implausible values and harmonize units. Statistical analyses were performed by computing individual health care system effect sizes and synthesizing these using random effect meta-analyses to account for heterogeneity. We focused the laboratory analysis on C-reactive protein (CRP), ferritin, fibrinogen, procalcitonin, D-dimer, and creatinine based on their reported associations with severe COVID-19. Results: Data were available for 79,613 patients, of which 32,467 were hospitalized in the first wave and 47,146 in the second wave. The prevalence of male patients and patients aged 50 to 69 years decreased significantly between the first and second waves. Patients hospitalized in the second wave had a 9.9% reduction in the risk of severe COVID-19 compared to patients hospitalized in the first wave (95% CI 8.5%-11.3%). Demographic subgroup analyses indicated that patients aged 26 to 49 years and 50 to 69 years; male and female patients; and black patients had significantly lower risk for severe disease in the second wave than in the first wave. At admission, the mean values of CRP were significantly lower in the second wave than in the first wave. On the seventh hospital day, the mean values of CRP, ferritin, fibrinogen, and procalcitonin were significantly lower in the second wave than in the first wave. In general, countries exhibited variable changes in laboratory testing rates from the first to the second wave. At admission, there was a significantly higher testing rate for D-dimer in France, Germany, and Spain. Conclusions: Patients hospitalized in the second wave were at significantly lower risk for severe COVID-19. This corresponded to mean laboratory values in the second wave that were more likely to be in typical physiological ranges on the seventh hospital day compared to the first wave. Our federated approach demonstrated the feasibility and power of harmonizing heterogeneous EHR data from multiple international health care systems to rapidly conduct large-scale studies to characterize how COVID-19 clinical trajectories evolve.-
Descrição: dc.descriptionNational Human Genome Research Institute-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences-
Descrição: dc.descriptionNational Heart, Lung, and Blood Institute-
Descrição: dc.descriptionNational Institutes of Health-
Descrição: dc.descriptionU.S. National Library of Medicine-
Descrição: dc.descriptionNational Institute of Neurological Disorders and Stroke-
Descrição: dc.descriptionCanadian Thoracic Society-
Descrição: dc.descriptionDepartment of Biomedical Informatics Harvard Medical School-
Descrição: dc.descriptionBIOMERIS (BIOMedical Research Informatics Solutions)-
Descrição: dc.descriptionClinical Research Unit Botucatu Medical School São Paulo State University-
Descrição: dc.descriptionDivision of Nephrology Department of Medicine Ente Ospedaliero Cantonale-
Descrição: dc.descriptionDepartment of Electrical Computer and Biomedical Engineering University of Pavia-
Descrição: dc.descriptionInformation Technology Department Azienda Socio-Sanitaria Territoriale di Pavia-
Descrição: dc.descriptionUnit of Internal Medicine and Endocrinology Istituti Clinici Scientifici Maugeri SpA SB IRCCS-
Descrição: dc.descriptionMassachusetts Veterans Epidemiology Research and Information Center Veterans Affairs Boston Healthcare System-
Descrição: dc.descriptionDepartment of Medicine Massachusetts General Hospital-
Descrição: dc.descriptionDepartment of Medicine David Geffen School of Medicine University of California Los Angeles-
Descrição: dc.descriptionHealth Informatics Hospital Universitario 12 de Octubre-
Descrição: dc.descriptionDepartment of Learning Health Sciences University of Michigan Medical School-
Descrição: dc.descriptionDepartment of Biomedical Informatics University of Kentucky-
Descrição: dc.descriptionDepartment of Biostatistics Epidemiology and Informatics University of Pennsylvania Perelman School of Medicine-
Descrição: dc.descriptionInstitute for Biomedical Informatics University of Pennsylvania Perelman School of Medicine-
Descrição: dc.descriptionDepartment of Preventive Medicine Northwestern University-
Descrição: dc.descriptionInstitute for Biomedical Informatics University of Kentucky-
Descrição: dc.descriptionMedical University of South Carolina-
Descrição: dc.descriptionDepartment of Computer Science Renaissance Computing Institute University of North Carolina at Chapel Hill-
Descrição: dc.descriptionDepartment of Biostatistics Harvard T.H. Chan School of Public Health-
Descrição: dc.descriptionDepartment of Anaesthesia National University Health System-
Descrição: dc.descriptionInstitute of Medical Biometry and Statistics Faculty of Medicine and Medical Center University of Freiburg-
Descrição: dc.descriptionMichigan Institute for Clinical & Health Research Informatics University of Michigan-
Descrição: dc.descriptionLaboratory of Informatics and Systems Engineering for Clinical Research Istituti Clinici Scientifici Maugeri SpA SB IRCCS-
Descrição: dc.descriptionClinical Hospital of Botucatu Medical School São Paulo State University-
Descrição: dc.descriptionInformatique et Archivistique Médicales Unit Bordeaux University Hospital-
Descrição: dc.descriptionDepartment of Biomedical Informatics University of Pittsburgh-
Descrição: dc.descriptionDepartment of Neurology Massachusetts General Hospital-
Descrição: dc.descriptionDepartment of Biomedical Informatics Hôpital Necker-Enfants Malade Assistance Publique Hôpitaux de Paris University of Paris-
Descrição: dc.descriptionDepartment of Biomedical Informatics Institute for Digital Medicine National University Health System-
Descrição: dc.descriptionInternal Medicine Department Botucatu Medical School São Paulo State University-
Descrição: dc.descriptionDepartment of Computational Medicine & Bioinformatics Internal Medicine Human Genetics and Public Health University of Michigan-
Descrição: dc.descriptionDivision of Medical Informatics Department of Internal Medicine University of Kansas Medical Center-
Descrição: dc.descriptionData Analytics Center University of Pennsylvania Health System-
Descrição: dc.descriptionDepartment of Medicine National University Health System-
Descrição: dc.descriptionDepartment of Neurology University of Pittsburgh-
Descrição: dc.descriptionSection of Nephrology Department of Pediatrics Brenner Children's Hospital Wake Forest School of Medicine-
Descrição: dc.descriptionClinical Research Unit Botucatu Medical School São Paulo State University-
Descrição: dc.descriptionClinical Hospital of Botucatu Medical School São Paulo State University-
Descrição: dc.descriptionInternal Medicine Department Botucatu Medical School São Paulo State University-
Descrição: dc.descriptionNational Human Genome Research Institute: 3U01HG008685-05S2-
Descrição: dc.descriptionNational Human Genome Research Institute: 5R01HG009174-04-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: 5UL1TR001857-05-
Descrição: dc.descriptionNational Heart, Lung, and Blood Institute: K23HL148394-
Descrição: dc.descriptionNational Heart, Lung, and Blood Institute: L40HL148910-
Descrição: dc.descriptionNational Institutes of Health: P30ES017885-
Descrição: dc.descriptionU.S. National Library of Medicine: R01LM012095-
Descrição: dc.descriptionU.S. National Library of Medicine: R01LM013345-
Descrição: dc.descriptionNational Institute of Neurological Disorders and Stroke: R01NS098023-
Descrição: dc.descriptionU.S. National Library of Medicine: T15LM007092-
Descrição: dc.descriptionNational Institutes of Health: U24CA210967-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR000005-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR001420-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR001450-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR001857-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR001878-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR001881-
Descrição: dc.descriptionCanadian Thoracic Society: UL1TR001998-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR002240-
Descrição: dc.descriptionCanadian Thoracic Society: UL1TR002366-
Descrição: dc.descriptionNational Center for Advancing Translational Sciences: UL1TR002541-
Idioma: dc.languageen-
Relação: dc.relationJournal of Medical Internet Research-
???dc.source???: dc.sourceScopus-
Palavras-chave: dc.subjectCOVID-19-
Palavras-chave: dc.subjectElectronic health records-
Palavras-chave: dc.subjectFederated study-
Palavras-chave: dc.subjectLaboratory trajectory-
Palavras-chave: dc.subjectMeta-analysis-
Palavras-chave: dc.subjectRetrospective cohort study-
Palavras-chave: dc.subjectSARS-CoV-2-
Palavras-chave: dc.subjectSevere COVID-19-
Título: dc.titleInternational changes in COVID-19 clinical trajectories across 315 hospitals and 6 countries: Retrospective cohort study-
Tipo de arquivo: dc.typelivro digital-
Aparece nas coleções:Repositório Institucional - Unesp

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