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从纵向实验室检测推断 COVID-19 相关凝血障碍 (CAC) 的时间演变。

Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC).

机构信息

nference, inc, Cambridge, United States.

Mayo Clinic, Rochester, United States.

出版信息

Elife. 2020 Aug 17;9:e59209. doi: 10.7554/eLife.59209.

DOI:10.7554/eLife.59209
PMID:32804081
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7473767/
Abstract

Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVID) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVID) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVID patients at the time of diagnostic testing, COVID patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVID patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVID patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.

摘要

从实验室检测结果进行时间推断，并与从非结构化电子健康记录 (EHR) 提供者记录中提取的临床结果进行三角剖分，是推进精准医学的关键。在这里，我们研究了 246 例 SARS-CoV-2 PCR 阳性（COVID）患者和 2460 例 SARS-CoV-2 PCR 阴性（COVID）患者，这些患者总共接受了约 70 万次实验室检测，涉及 194 项检测。与诊断性检测时的 COVID 患者相比，COVID 患者的血浆纤维蛋白原水平更高，血小板计数更低。然而，随着感染的发展，COVID 患者的纤维蛋白原显著下降，血小板计数增加，白细胞计数降低。对 EHR 的增强管理表明，只有少数 COVID 患者会发生血栓栓塞，很少发生弥散性血管内凝血 (DIC)，患者通常不会出现消耗性凝血病的典型血小板减少。这些时间趋势为 COVID-19 相关凝血障碍 (CAC) 提供了精细的分辨率，并为个体化抗血栓形成治疗奠定了基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/97cb7d4ebf30/elife-59209-fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/25c2240f4771/elife-59209-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/6978c37d9a75/elife-59209-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/0d815fe6b5a5/elife-59209-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/118712815252/elife-59209-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/f0afbe89c0cc/elife-59209-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/97cb7d4ebf30/elife-59209-fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/25c2240f4771/elife-59209-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/6978c37d9a75/elife-59209-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/0d815fe6b5a5/elife-59209-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/118712815252/elife-59209-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/f0afbe89c0cc/elife-59209-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7f7/7473767/97cb7d4ebf30/elife-59209-fig6.jpg

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