Abstract
BackgroundThe COVID-19 pandemic represents a major public health threat. Risk of death from the infection is associated with age and pre-existing comorbidities such as diabetes, dementia, cancer, and impairment of immunological, hepatic or renal function. It remains incompletely understood why some patients survive the disease, while others do not. As such, we sought to identify novel prognostic factors for COVID-19 mortality.MethodsWe performed an unbiased, observational retrospective analysis of real world data. Our multivariable and univariable analyses make use of U.S. electronic health records from 122,250 COVID-19 patients in the early stages of the pandemic.ResultsHere we show that a priori diagnoses of fluid, pH and electrolyte imbalance during the year preceding the infection are associated with an increased risk of death independently of age and prior renal comorbidities.ConclusionsWe propose that future interventional studies should investigate whether the risk of death can be alleviated by diligent and personalized management of the fluid and electrolyte balance of at-risk individuals during and before COVID-19.
Highlights
Background The COVID19 pandemic represents a major public health threat
We present an agnostic and data-driven analysis of real world data from U.S electronic health records (EHR) of 122,250 COVID-19 patients to identify a priori factors associated with death during a COVID-19 infection
We suggest that balancing electrolyte homeostasis in COVID-19 patients offers opportunities for better care and/or prevention of the severe disease
Summary
Observational retrospective analysis of real world data. Our multivariable and univariable analyses make use of U.S electronic health records from 122,250 COVID-19 patients in the early stages of the pandemic. We extracted 122,250 COVID-19 cases collected by Optum® with a diagnosis date between 20 February and 1 July 2020 (Supplementary Data 1). The Optum® de-identified COVID-19 EHR dataset contains patient-level medical and administrative records from hospitals, emergency departments, outpatient centers, and laboratories from across the United States. Mortality information is derived from combining data from the Social Security Death Master File, hospital reports on patient deaths, and third party obituary sources. The COVID-19 EHR dataset sources clinical information from hospital networks that provide data meeting Optum’s internal data quality criteria. We confirmed COVID-19 diagnosis either by documented ICD-10 codes (Supplementary Information: Data Preparation) or via positive PCR test result (Supplementary Data 2). Survival time was computed as the number of days between the date of COVID-19 diagnosis and last documented clinical activity (vitals, labs, medication, encounter, collected until 13 July 2020) or documented death
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