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

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(pos)) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVID(neg)) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVID(neg) patients at the time of diagnostic testing, COVID(pos) patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVID(pos) 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(pos) 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.