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

March 26,2021

Aug. 17, 2020

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 (COVIDpos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVIDneg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVIDneg patients at the time of diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVIDpos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVIDpos 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.

Colin Pawlowski1Tyler Wagner1Arjun Puranik1Karthik Murugadoss1Liam Loscalzo1Rajiv K. Pruthi2Damon E Houghton2John C. O’Horo2William G. Morice II2,3Amy W Williams2Gregory J Gores2John Halamka2,4 ,Andrew D. Badley2Elliot S. Barnathan5Hideo Makimura5Najat Khan5Venky Soundararajan1
1nference, Cambridge, MA 02142
2Mayo Clinic, Rochester, MN 55905
3Mayo Clinic Laboratories, Rochester, MN 55905
4Mayo Clinic Platform, Rochester, MN 55905
5Janssen pharmaceutical companies of Johnson & Johnson (J&J), Spring House, United States.
Correspondence: Venky Soundararajan (
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© 2020, Pawlowski et al. This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.