Analysis of electronic medical records to identify sequelae of COVID-19

A recent study published in the journal emerging infectious disease, researchers analyzed and compared pre- and post-COVID-19 diagnostic codes to identify symptoms that had a higher incidence in the post-COVID-19 period as sequelae. The sequelae of COVID-19 and future emerging diseases can be generated and monitored using this method.

study: Longitudinal analysis of electronic health information to identify possible sequelae of COVID-19Image credit: p.ill.i / Shutterstock

SARS-CoV-2 is the causative agent of the 2019 coronavirus disease and can cause several health conditions including various long-term sequelae following infection. Previous studies have reported post-acute symptoms of COVID-19, including chest pain, malaise, fatigue, and conditions such as renal failure, cardiomyopathy, venous thromboembolism, and lung disease.

Clinical experience has been documented to identify possible sequelae of emerging diseases. However, this approach may miss rare sequelae or those with less obvious parameter increases. Large electronic medical record databases can help detect early warning signs, especially when the events leading to possible sequelae are dispersed over time.

About research

The purpose of this study was to compare diagnostic codes before the outbreak of COVID-19 with diagnostic codes after acute COVID-19 to identify potential COVID-19 sequelae in a national database of medical visits in the United States (US). was to identify

The PHD-SR (Premier Healthcare Database, Special Coronavirus Disease 2019 Release) database published on 4 February 2021 was used for the analysis. In addition, we analyzed variables for type of medical visit (outpatient, inpatient, outpatient, emergency visit) and order of visit date.

Visit date variables included date of admission, length of stay, time between medical visits, month of discharge), and ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code at time of discharge. was First outpatient or inpatient with COVID-19 discharged between 1 January 2019 and 31 December 2020 (i.e., her ICD for discharge after COVID-19-related hospitalization) 10-CM code) were analyzed. Pregnant women were excluded from the analysis.

The index date for COVID-19 considered was the date of first medical visit. Medical visits during the pre-SARS-CoV-2 infection period consisted of the individual’s first medical visit with COVID-19 one year earlier. Healthcare encounters in the post-SARS-CoV-2 period consisted of the first healthcare encounter with COVID-19 and subsequent health encounters.

The RR (relative ratio) of post-SARS-CoV-2 diagnosis to pre-SARS-CoV-2 diagnosis was calculated for the period following acute COVID-19, 60 to 89 days, 90 to 119 days, and 120 to 149 days, where 0 represents the index date.Diagnosis with Significantly Higher Healthcare Encounter Rates >60.0 days after the index day before SARS-CoV-2 infection was defined as likely sequelae of acute SARS-CoV-2 infection.

result

A total of 385,067 eligible individuals were considered for analysis, most (59%) of whom were female with a median age of 54 years. and one encounter after SARS-CoV-2 infection. Most of the encounters (87%) were in the outpatient setting, and her median length of stay in the inpatient setting was 4.0 days.

Hospital visits related to parasitic and infectious sequelae increased over 149.0 days after the index COVID-19 date (RR 120 to 149 days). Additionally, several months into the acute post-COVID-19 period, physicians encountered cases of headache, fatigue, pneumonia, and ARDS (acute respiratory distress syndrome).

Myopathy (RR 5.0 from 60 to 89 days), polyneuropathy (90 to 119 days RR 9.1), pressure ulcers (stages 3 and 4, 60 to 89 days) RR of 1.6 to 1.7) and hair loss without scarring (RR of 2.3 to 3.5 at several intervals after 60 days). Codes of sepsis and cardiomyopathy (RR of 9.8 over a period of 60 to 89 days) increased only in the first 90 days after the index day.

Although the incidence of nonfollicular diffuse lymphoma increased from 60 days to 119 days (RR 273 to 411), most hospital visits were reported for 1 COVID-19 patient.Encounter with Medical Care for Tertiary Chronic Kidney Disease [glomerular filtration rate (GFR) values of 30 to 59 mL/min/1.7 m²] At 2 months, RRs ranged from 2.5 to 6.4, and elevated hepatic aminotransferase levels (RR from 4.8 to 6.5 after 60.0 days) were observed in months after index days throughout the period of 120 to 149 days after acute COVID-19. increased over time. .

The incidence of infectious myocarditis (RR 13) was more pronounced between days 90 and 119. The potential respiratory, cardiac, hepatic, and renal COVID-19 sequelae identified in this study were consistent with the results of previously published studies. There were more cases of stage III renal disease in the post-SARS-CoV-2 period than in the pre-SARS-CoV-2 period.

Overall, the results of the study will help identify the first signs of possible sequelae of new emerging diseases, and provide guidance for identifying, characterizing and refining possible sequelae of COVID-19 and other diseases. We have demonstrated a hypothesis generation approach that can inform studies. The results of this study are in line with those of other studies that have used a variety of methods to identify possible COVID-19 sequelae, including directly examining an individual with or without his previous COVID-19 test results. was consistent.