Utilization of machine-learning models to accurately predict the risk for critical COVID-19

Machine learning algorithms for predicting COVID-19 mortality in Ethiopia

BACKGROUND

Coronavirus disease 2019 (COVID-19), a global public health crisis, continues to pose challenges despite preventive measures. The daily rise in COVID-19 cases is concerning, and the testing process is both time-consuming and costly. While several models have been created to predict mortality in COVID-19 patients, only a few have shown sufficient accuracy. Machine learning algorithms offer a promising approach to data-driven prediction of clinical outcomes, surpassing traditional statistical modeling. Leveraging machine learning (ML) algorithms could potentially provide a solution for predicting mortality in hospitalized COVID-19 patients in Ethiopia. Therefore, the aim of this study is to develop and validate machine-learning models for accurately predicting mortality in COVID-19 hospitalized patients in Ethiopia.

METHODS

Our study involved analyzing electronic medical records of COVID-19 patients who were admitted to public hospitals in Ethiopia. Specifically, we developed seven different machine learning models to predict COVID-19 patient mortality. These models included J48 decision tree, random forest (RF), k-nearest neighborhood (k-NN), multi-layer perceptron (MLP), Naïve Bayes (NB), eXtreme gradient boosting (XGBoost), and logistic regression (LR). We then compared the performance of these models using data from a cohort of 696 patients through statistical analysis. To evaluate the effectiveness of the models, we utilized metrics derived from the confusion matrix such as sensitivity, specificity, precision, and receiver operating characteristic (ROC).

RESULTS

The study included a total of 696 patients, with a higher number of females (440 patients, accounting for 63.2%) compared to males. The median age of the participants was 35.0 years old, with an interquartile range of 18-79. After conducting different feature selection procedures, 23 features were examined, and identified as predictors of mortality, and it was determined that gender, Intensive care unit (ICU) admission, and alcohol drinking/addiction were the top three predictors of COVID-19 mortality. On the other hand, loss of smell, loss of taste, and hypertension were identified as the three lowest predictors of COVID-19 mortality. The experimental results revealed that the k-nearest neighbor (k-NN) algorithm outperformed than other machine learning algorithms, achieving an accuracy of 95.25%, sensitivity of 95.30%, precision of 92.7%, specificity of 93.30%, F1 score 93.98% and a receiver operating characteristic (ROC) score of 96.90%. These findings highlight the effectiveness of the k-NN algorithm in predicting COVID-19 outcomes based on the selected features.

CONCLUSION

Our study has developed an innovative model that utilizes hospital data to accurately predict the mortality risk of COVID-19 patients. The main objective of this model is to prioritize early treatment for high-risk patients and optimize strained healthcare systems during the ongoing pandemic. By integrating machine learning with comprehensive hospital databases, our model effectively classifies patients' mortality risk, enabling targeted medical interventions and improved resource management. Among the various methods tested, the K-nearest neighbors (KNN) algorithm demonstrated the highest accuracy, allowing for early identification of high-risk patients. Through KNN feature identification, we identified 23 predictors that significantly contribute to predicting COVID-19 mortality. The top five predictors are gender (female), intensive care unit (ICU) admission, alcohol drinking, smoking, and symptoms of headache and chills. This advancement holds great promise in enhancing healthcare outcomes and decision-making during the pandemic. By providing services and prioritizing patients based on the identified predictors, healthcare facilities and providers can improve the chances of survival for individuals. This model provides valuable insights that can guide healthcare professionals in allocating resources and delivering appropriate care to those at highest risk.

Is it possible to estimate the number of patients with COVID-19 admitted to intensive care units and general wards using clinical and telemedicine data?

BACKGROUND

Gabaldi et al. utilized telemedicine data, web search trends, hospitalized patient characteristics, and resource usage data to estimate bed occupancy during the COVID-19 pandemic. The results showcase the potential of data-driven strategies to enhance resource allocation decisions for an effective pandemic response.

OBJECTIVE

To develop and validate predictive models to estimate the number of COVID-19 patients hospitalized in the intensive care units and general wards of a private not-for-profit hospital in São Paulo, Brazil.

METHODS

Two main models were developed. The first model calculated hospital occupation as the difference between predicted COVID-19 patient admissions, transfers between departments, and discharges, estimating admissions based on their weekly moving averages, segmented by general wards and intensive care units. Patient discharge predictions were based on a length of stay predictive model, assessing the clinical characteristics of patients hospitalized with COVID-19, including age group and usage of mechanical ventilation devices. The second model estimated hospital occupation based on the correlation with the number of telemedicine visits by patients diagnosed with COVID-19, utilizing correlational analysis to define the lag that maximized the correlation between the studied series. Both models were monitored for 365 days, from May 20th, 2021, to May 20th, 2022.

RESULTS

The first model predicted the number of hospitalized patients by department within an interval of up to 14 days. The second model estimated the total number of hospitalized patients for the following 8 days, considering calls attended by Hospital Israelita Albert Einstein's telemedicine department. Considering the average daily predicted values for the intensive care unit and general ward across a forecast horizon of 8 days, as limited by the second model, the first and second models obtained R² values of 0.900 and 0.996, respectively and mean absolute errors of 8.885 and 2.524 beds, respectively. The performances of both models were monitored using the mean error, mean absolute error, and root mean squared error as a function of the forecast horizon in days.

CONCLUSION

The model based on telemedicine use was the most accurate in the current analysis and was used to estimate COVID-19 hospital occupancy 8 days in advance, validating predictions of this nature in similar clinical contexts. The results encourage the expansion of this method to other pathologies, aiming to guarantee the standards of hospital care and conscious consumption of resources.

BACKGROUND

Developed models to forecast bed occupancy for up to 14 days and monitored errors for 365 days.

BACKGROUND

Telemedicine calls from COVID-19 patients correlated with the number of patients hospitalized in the next 8 days.

Exploring the opportunities and challenges of implementing artificial intelligence in healthcare: A systematic literature review

Recent progress in the realm of artificial intelligence has shown effectiveness in various industries, particularly within the healthcare sector. However, there are limited insights on existing studies regarding ethical, social, privacy, and technological aspects of AI in the health sector, which is the gap our study aims to fill. This study aimed to synthesize empirical studies on the challenges and opportunities of using AI by conducting a systematic review. We reviewed 33 articles published between 2015 and 2022 in the PubMed, IEEE Xplore, and Science Direct databases. The results show that artificial intelligence has the promise of improving health care and faces obstacles when implemented. Most of the reviewed studies indicated that the use of AI provides several opportunities, including teamwork and decision-making, technological advancement, diagnosis and patient monitoring, drug development, and virtual health assistance. However, the findings show that the use of AI in the health sector hinders multifaceted challenges, including ethical and privacy-related issues, lack of awareness, unreliability of technology, and professional liability. The findings highlight that artificial intelligence has the potential to transform healthcare and that addressing these challenges is crucial to fully utilize its potential.

Protective effects of IL18-105G > A and IL18-137C > Ggenetic variants on severity of COVID-19

OBJECTIVE AND DESIGN

A cross-sectional study evaluated the IL18-105G > A (rs360717) and IL18-137C > G (rs187238) variants on Coronavírus Disease 2019 (COVID-19) severity.

SUBJECTS AND METHODS

528 patients with COVID-19 classifed with mild (n = 157), moderate (n = 63) and critical (n = 308) disease were genotpyed for the IL18-105G > A and IL18-137C > G variants.

RESULTS

We observed associations between severe + critical COVID-19 groups (reference group was mild COVID-19) and the IL18-105G > A (p = 0.008) and IL18-137C > G (p = 0.01) variants, which remained significant after adjusting for sex, ethnicity and age. Consequently, we have examined the associations between moderate + critical COVID-19 and the genotypes of both variants using different genetic models. The IL18-105G > A was associated with severe disease (moderate + critical), with effects of the GA genotype in the codominant [Odds ratio (OR), (95 % confidence interval) 0.55, 0.34-0.89, p = 0.015], overdominant (0.56, 0.35-0.89, p = 0.014) and dominant (0.60, 0.38-0.96, p = 0.031) models. IL18-105 GA coupled with age, chest computed tomograhy scan anormalities, body mass index, heart diseases, type 2 diabetes mellitus, hypertension, and inflammation may be used to predict the patients who develop severe disease with an accuracy of 84.3 % (sensitivity: 83.3 % and specificity: 86.5 %). Therefore, the presence of the IL18-105 A allele in homozygosis or heterozygosis conferred about 44.0 % of protection in the development of moderate and severe COVID-19. The IL18-137C > G variant was also associated with protective effects in the codominant (0.55, 0.34-0.89, p = 0.015), overdominant (0.57, 0.36-0.91, p = 0.018), and dominant models (0.59, 0.37-0.93, p = 0.025). Therefore, the IL18-137 G allele showed a protective effect against COVID-19 severity.

CONCLUSION

The IL18-105G > A and IL18-137C > Gvariants may contribute with protective effects for COVID-19 severity and the effects of IL18-137C > G may be modulating IL-18 production and Th1-mediated immune responses.

Machine and deep learning methods for clinical outcome prediction based on physiological data of COVID-19 patients: a scoping review

INTRODUCTION

Since the beginning of the COVID-19 pandemic, numerous machine and deep learning (MDL) methods have been proposed in the literature to analyze patient physiological data. The objective of this review is to summarize various aspects of these methods and assess their practical utility for predicting various clinical outcomes.

METHODS

We searched PubMed, Scopus, and Cochrane Library, screened and selected the studies matching the inclusion criteria. The clinical analysis focused on the characteristics of the patient cohorts in the studies included in this review, the specific tasks in the context of the COVID-19 pandemic that machine and deep learning methods were used for, and their practical limitations. The technical analysis focused on the details of specific MDL methods and their performance.

RESULTS

Analysis of the 48 selected studies revealed that the majority (∼54 %) of them examined the application of MDL methods for the prediction of survival/mortality-related patient outcomes, while a smaller fraction (∼13 %) of studies also examined applications to the prediction of patients' physiological outcomes and hospital resource utilization. 21 % of the studies examined the application of MDL methods to multiple clinical tasks. Machine and deep learning methods have been shown to be effective at predicting several outcomes of COVID-19 patients, such as disease severity, complications, intensive care unit (ICU) transfer, and mortality. MDL methods also achieved high accuracy in predicting the required number of ICU beds and ventilators.

CONCLUSION

Machine and deep learning methods have been shown to be valuable tools for predicting disease severity, organ dysfunction and failure, patient outcomes, and hospital resource utilization during the COVID-19 pandemic. The discovered knowledge and our conclusions and recommendations can also be useful to healthcare professionals and artificial intelligence researchers in managing future pandemics.

Hybrid grey assisted whale optimization based machine learning for the COVID-19 prediction

Recently, COVID-19 (coronavirus) has been a huge influence on the socio and economic field. COVID-19 cases are seriously increasing day-day and also don't identified proper vaccine for COVID-19. Hence, COVID-19 is fast spreading virus and it causes more deaths. In order to address this, the work has proposed a machine learning (ML) scheme for the prediction of COVID-19 positive, negative, and deceased instances. Initially, the data is pre-processed by eliminating redundant and missing values. Then, the features are selected using hybrid grey assisted whale optimization algorithm (H-GAWOA). Finally, the classifier ANFIS (adaptive network-based fuzzy inference systems) is used for investigating the confirmed, survival and death rate of COVID-19. The performance is analysed on John Hopkins University dataset and the performances like MSE, RMSE, MAPE, and R2 are measured. In all the comparisons, the MSE value is very less for the proposed model. Particularly, in the deceased cases prediction, the MSE value is 0.00 for the proposed H-GAWOA-ANFIS. Finally, it is proved that the suggested model is able to generate the better results when contrast to the other approaches.

Developing an interpretable machine learning model for predicting COVID-19 patients deteriorating prior to intensive care unit admission using laboratory markers

Coronavirus disease (COVID-19) remains a significant global health challenge, prompting a transition from emergency response to comprehensive management strategies. Furthermore, the emergence of new variants of concern, such as BA.2.286, underscores the need for early detection and response to new variants, which continues to be a crucial strategy for mitigating the impact of COVID-19, especially among the vulnerable population. This study aims to anticipate patients requiring intensive care or facing elevated mortality risk throughout their COVID-19 infection while also identifying laboratory predictive markers for early diagnosis of patients. Therefore, haematological, biochemical, and demographic variables were retrospectively evaluated in 8,844 blood samples obtained from 2,935 patients before intensive care unit admission using an interpretable machine learning model. Feature selection techniques were applied using precision-recall measures to address data imbalance and evaluate the suitability of the different variables. The model was trained using stratified cross-validation with k=5 and internally validated, achieving an accuracy of 77.27%, sensitivity of 78.55%, and area under the receiver operating characteristic (AUC) of 0.85; successfully identifying patients at increased risk of severe progression. From a medical perspective, the most important features of the progression or severity of patients with COVID-19 were lactate dehydrogenase, age, red blood cell distribution standard deviation, neutrophils, and platelets, which align with findings from several prior investigations. In light of these insights, diagnostic processes can be significantly expedited through the use of laboratory tests, with a greater focus on key indicators. This strategic approach not only improves diagnostic efficiency but also extends its reach to a broader spectrum of patients. In addition, it allows healthcare professionals to take early preventive measures for those most at risk of adverse outcomes, thereby optimising patient care and prognosis.

Multidimensional dynamic prediction model for hospitalized patients with the omicron variant in China

Purpose

To establish dynamic prediction models by machine learning using daily multidimensional data for coronavirus disease 2019 (COVID-19) patients.

Methods

Hospitalized COVID-19 patients at Peking Union Medical College Hospital from Nov 2nd, 2022, to Jan 13th, 2023, were enrolled in this study. The outcome was defined as deterioration or recovery of the patient's condition. Demographics, comorbidities, laboratory test results, vital signs, and treatments were used to train the model. To predict the following days, a separate XGBoost model was trained and validated. The Shapley additive explanations method was used to analyze feature importance.

Results

A total of 995 patients were enrolled, generating 7228 and 3170 observations for each prediction model. In the deterioration prediction model, the minimum area under the receiver operating characteristic curve (AUROC) for the following 7 days was 0.786 (95% CI 0.721-0.851), while the AUROC on the next day was 0.872 (0.831-0.913). In the recovery prediction model, the minimum AUROC for the following 3 days was 0.675 (0.583-0.767), while the AUROC on the next day was 0.823 (0.770-0.876). The top 5 features for deterioration prediction on the 7th day were disease course, length of hospital stay, hypertension, and diastolic blood pressure. Those for recovery prediction on the 3rd day were age, D-dimer levels, disease course, creatinine levels and corticosteroid therapy.

Conclusion

The models could accurately predict the dynamics of Omicron patients' conditions using daily multidimensional variables, revealing important features including comorbidities (e.g., hyperlipidemia), age, disease course, vital signs, D-dimer levels, corticosteroid therapy and oxygen therapy.

Early and fair COVID-19 outcome risk assessment using robust feature selection

Personalized medicine plays an important role in treatment optimization for COVID-19 patient management. Early treatment in patients at high risk of severe complications is vital to prevent death and ventilator use. Predicting COVID-19 clinical outcomes using machine learning may provide a fast and data-driven solution for optimizing patient care by estimating the need for early treatment. In addition, it is essential to accurately predict risk across demographic groups, particularly those underrepresented in existing models. Unfortunately, there is a lack of studies demonstrating the equitable performance of machine learning models across patient demographics. To overcome this existing limitation, we generate a robust machine learning model to predict patient-specific risk of death or ventilator use in COVID-19 positive patients using features available at the time of diagnosis. We establish the value of our solution across patient demographics, including gender and race. In addition, we improve clinical trust in our automated predictions by generating interpretable patient clustering, patient-level clinical feature importance, and global clinical feature importance within our large real-world COVID-19 positive patient dataset. We achieved 89.38% area under receiver operating curve (AUROC) performance for severe outcomes prediction and our robust feature ranking approach identified the presence of dementia as a key indicator for worse patient outcomes. We also demonstrated that our deep-learning clustering approach outperforms traditional clustering in separating patients by severity of outcome based on mutual information performance. Finally, we developed an application for automated and fair patient risk assessment with minimal manual data entry using existing data exchange standards.

Machine learning: Predicting hospital length of stay in patients admitted for lupus flares

BACKGROUND

Although rare, severe systemic lupus erythematosus (SLE) flares requiring hospitalization account for most of the direct costs of SLE care. New machine learning (ML) methods may optimize lupus care by predicting which patients will have a prolonged hospital length of stay (LOS). Our study uses a machine learning approach to predict the LOS in patients admitted for lupus flares and assesses which features prolong LOS.

METHODS

Our study sampled 5831 patients admitted for lupus flares from the National Inpatient Sample Database 2016-2018 and collected 90 demographics and comorbidity features. Four machine learning (ML) models were built (XGBoost, Linear Support Vector Machines, K Nearest Neighbors, and Logistic Regression) to predict LOS, and their performance was evaluated using multiple metrics, including accuracy, receiver operator area under the curve (ROC-AUC), precision-recall area under the curve (PR- AUC), and F1-score. Using the highest-performing model (XGBoost), we assessed the feature importance of our input features using Shapley value explanations (SHAP) to rank their impact on LOS.

RESULTS

Our XGB model performed the best with a ROC-AUC of 0.87, PR-AUC of 0.61, an F1 score of 0.56, and an accuracy of 95%. The features with the most significant impact on the model were "the need for a central line," "acute dialysis," and "acute renal failure." Other top features include those related to renal and infectious comorbidities.

CONCLUSION

Our results were consistent with the established literature and showed promise in ML over traditional methods of predictive analyses, even with rare rheumatic events such as lupus flare hospitalizations.

Making the Improbable Possible: Generalizing Models Designed for a Syndrome-Based, Heterogeneous Patient Landscape

Syndromic conditions, such as sepsis, are commonly encountered in the intensive care unit. Although these conditions are easy for clinicians to grasp, these conditions may limit the performance of machine-learning algorithms. Individual hospital practice patterns may limit external generalizability. Data missingness is another barrier to optimal algorithm performance and various strategies exist to mitigate this. Recent advances in data science, such as transfer learning, conformal prediction, and continual learning, may improve generalizability of machine-learning algorithms in critically ill patients. Randomized trials with these approaches are indicated to demonstrate improvements in patient-centered outcomes at this point.

Improving prediction of COVID-19 mortality using machine learning in the Spanish SEMI-COVID-19 registry

COVID-19 is responsible for high mortality, but robust machine learning-based predictors of mortality are lacking. To generate a model for predicting mortality in patients hospitalized with COVID-19 using Gradient Boosting Decision Trees (GBDT). The Spanish SEMI-COVID-19 registry includes 24,514 pseudo-anonymized cases of patients hospitalized with COVID-19 from 1 February 2020 to 5 December 2021. This registry was used as a GBDT machine learning model, employing the CatBoost and BorutaShap classifier to select the most relevant indicators and generate a mortality prediction model by risk level, ranging from 0 to 1. The model was validated by separating patients according to admission date, using the period 1 February to 31 December 2020 (first and second waves, pre-vaccination period) for training, and 1 January to 30 November 2021 (vaccination period) for the test group. An ensemble of ten models with different random seeds was constructed, separating 80% of the patients for training and 20% from the end of the training period for cross-validation. The area under the receiver operating characteristics curve (AUC) was used as a performance metric. Clinical and laboratory data from 23,983 patients were analyzed. CatBoost mortality prediction models achieved an AUC performance of 84.76 (standard deviation 0.45) for patients in the test group (potentially vaccinated patients not included in model training) using 16 features. The performance of the 16-parameter GBDT model for predicting COVID-19 hospital mortality, although requiring a relatively large number of predictors, shows a high predictive capacity.

Comparing machine learning algorithms to predict COVID‑19 mortality using a dataset including chest computed tomography severity score data

Since the beginning of the COVID-19 pandemic, new and non-invasive digital technologies such as artificial intelligence (AI) had been introduced for mortality prediction of COVID-19 patients. The prognostic performances of the machine learning (ML)-based models for predicting clinical outcomes of COVID-19 patients had been mainly evaluated using demographics, risk factors, clinical manifestations, and laboratory results. There is a lack of information about the prognostic role of imaging manifestations in combination with demographics, clinical manifestations, and laboratory predictors. The purpose of the present study is to develop an efficient ML prognostic model based on a more comprehensive dataset including chest CT severity score (CT-SS). Fifty-five primary features in six main classes were retrospectively reviewed for 6854 suspected cases. The independence test of Chi-square was used to determine the most important features in the mortality prediction of COVID-19 patients. The most relevant predictors were used to train and test ML algorithms. The predictive models were developed using eight ML algorithms including the J48 decision tree (J48), support vector machine (SVM), multi-layer perceptron (MLP), k-nearest neighbourhood (k-NN), Naïve Bayes (NB), logistic regression (LR), random forest (RF), and eXtreme gradient boosting (XGBoost). The performances of the predictive models were evaluated using accuracy, precision, sensitivity, specificity, and area under the ROC curve (AUC) metrics. After applying the exclusion criteria, a total of 815 positive RT-PCR patients were the final sample size, where 54.85% of the patients were male and the mean age of the study population was 57.22 ± 16.76 years. The RF algorithm with an accuracy of 97.2%, the sensitivity of 100%, a precision of 94.8%, specificity of 94.5%, F1-score of 97.3%, and AUC of 99.9% had the best performance. Other ML algorithms with AUC ranging from 81.2 to 93.9% had also good prediction performances in predicting COVID-19 mortality. Results showed that timely and accurate risk stratification of COVID-19 patients could be performed using ML-based predictive models fed by routine data. The proposed algorithm with the more comprehensive dataset including CT-SS could efficiently predict the mortality of COVID-19 patients. This could lead to promptly targeting high-risk patients on admission, the optimal use of hospital resources, and an increased probability of survival of patients.

Rapid Triage of Children with Suspected COVID-19 Using Laboratory-Based Machine-Learning Algorithms

In order to limit the spread of the novel betacoronavirus (SARS-CoV-2), it is necessary to detect positive cases as soon as possible and isolate them. For this purpose, machine-learning algorithms, as a field of artificial intelligence, have been recognized as a promising tool. The aim of this study was to assess the utility of the most common machine-learning algorithms in the rapid triage of children with suspected COVID-19 using easily accessible and inexpensive laboratory parameters. A cross-sectional study was conducted on 566 children treated for respiratory diseases: 280 children with PCR-confirmed SARS-CoV-2 infection and 286 children with respiratory symptoms who were SARS-CoV-2 PCR-negative (control group). Six machine-learning algorithms, based on the blood laboratory data, were tested: random forest, support vector machine, linear discriminant analysis, artificial neural network, k-nearest neighbors, and decision tree. The training set was validated through stratified cross-validation, while the performance of each algorithm was confirmed by an independent test set. Random forest and support vector machine models demonstrated the highest accuracy of 85% and 82.1%, respectively. The models demonstrated better sensitivity than specificity and better negative predictive value than positive predictive value. The F1 score was higher for the random forest than for the support vector machine model, 85.2% and 82.3%, respectively. This study might have significant clinical applications, helping healthcare providers identify children with COVID-19 in the early stage, prior to PCR and/or antigen testing. Additionally, machine-learning algorithms could improve overall testing efficiency with no extra costs for the healthcare facility.

Predicting intensive care need for COVID-19 patients using deep learning on chest radiography

Purpose

Image-based prediction of coronavirus disease 2019 (COVID-19) severity and resource needs can be an important means to address the COVID-19 pandemic. In this study, we propose an artificial intelligence/machine learning (AI/ML) COVID-19 prognosis method to predict patients' needs for intensive care by analyzing chest X-ray radiography (CXR) images using deep learning.

Approach

The dataset consisted of 8357 CXR exams from 5046 COVID-19-positive patients as confirmed by reverse transcription polymerase chain reaction (RT-PCR) tests for the SARS-CoV-2 virus with a training/validation/test split of 64%/16%/20% on a by patient level. Our model involved a DenseNet121 network with a sequential transfer learning technique employed to train on a sequence of gradually more specific and complex tasks: (1) fine-tuning a model pretrained on ImageNet using a previously established CXR dataset with a broad spectrum of pathologies; (2) refining on another established dataset to detect pneumonia; and (3) fine-tuning using our in-house training/validation datasets to predict patients' needs for intensive care within 24, 48, 72, and 96 h following the CXR exams. The classification performances were evaluated on our independent test set (CXR exams of 1048 patients) using the area under the receiver operating characteristic curve (AUC) as the figure of merit in the task of distinguishing between those COVID-19-positive patients who required intensive care following the imaging exam and those who did not.

Results

Our proposed AI/ML model achieved an AUC (95% confidence interval) of 0.78 (0.74, 0.81) when predicting the need for intensive care 24 h in advance, and at least 0.76 (0.73, 0.80) for 48 h or more in advance using predictions based on the AI prognostic marker derived from CXR images.

Conclusions

This AI/ML prediction model for patients' needs for intensive care has the potential to support both clinical decision-making and resource management.

Deep learning for deterioration prediction of COVID-19 patients based on time-series of three vital signs

Unrecognized deterioration of COVID-19 patients can lead to high morbidity and mortality. Most existing deterioration prediction models require a large number of clinical information, typically collected in hospital settings, such as medical images or comprehensive laboratory tests. This is infeasible for telehealth solutions and highlights a gap in deterioration prediction models based on minimal data, which can be recorded at a large scale in any clinic, nursing home, or even at the patient's home. In this study, we develop and compare two prognostic models that predict if a patient will experience deterioration in the forthcoming 3 to 24 h. The models sequentially process routine triadic vital signs: (a) oxygen saturation, (b) heart rate, and (c) temperature. These models are also provided with basic patient information, including sex, age, vaccination status, vaccination date, and status of obesity, hypertension, or diabetes. The difference between the two models is the way that the temporal dynamics of the vital signs are processed. Model #1 utilizes a temporally-dilated version of the Long-Short Term Memory model (LSTM) for temporal processes, and Model #2 utilizes a residual temporal convolutional network (TCN) for this purpose. We train and evaluate the models using data collected from 37,006 COVID-19 patients at NYU Langone Health in New York, USA. The convolution-based model outperforms the LSTM based model, achieving a high AUROC of 0.8844-0.9336 for 3 to 24 h deterioration prediction on a held-out test set. We also conduct occlusion experiments to evaluate the importance of each input feature, which reveals the significance of continuously monitoring the variation of the vital signs. Our results show the prospect for accurate deterioration forecast using a minimum feature set that can be relatively easily obtained using wearable devices and self-reported patient information.

A machine learning and explainable artificial intelligence triage-prediction system for COVID-19

COVID-19 is a respiratory disease caused by the SARS-CoV-2 contagion, severely disrupted the healthcare infrastructure. Various countries have developed COVID-19 vaccines that have effectively prevented the severe symptoms caused by the virus to a certain extent. However, a small section of people continues to perish. Artificial intelligence advances have revolutionized healthcare diagnosis and prognosis infrastructure. In this study, we predict the severity of COVID-19 using heterogenous Machine Learning and Deep Learning algorithms by considering clinical markers, vital signs, and other critical factors. This study extensively reviews various classifier architectures to predict the COVID-19 severity. We built and evaluated multiple pipelines entailing combinations of five state-of-the-art data-balancing techniques (Synthetic Minority Oversampling Technique (SMOTE), Adaptive Synthetic, Borderline SMOTE, SMOTE with Tomek links, and SMOTE with Edited Nearest Neighbor (ENN)) and twelve heterogeneous classifiers such as Logistic Regression, Decision Tree, Random Forest, Support Vector Machine, K-Nearest Neighbors, Naïve Bayes, Xgboost, Extratrees, Adaboost, Light GBM, Catboost, and 1-D Convolution Neural Network. The best-performing pipeline consists of Random Forest trained on Borderline SMOTE balanced data that produced the highest recall of 83%. We deployed Explainable Artificial Intelligence tools such as Shapley Additive Explanations and Local Interpretable Model-agnostic Explanations, ELI5, Qlattice, Anchor, and Feature Importance to demystify complex tree-based ensemble models. These tools provide valuable insights into the significance of critical features in the severity prediction of a COVID-19 patient. It was observed that changes in respiratory rate, blood pressure, lactate, and calcium values were the primary contributors to the increase in severity of a COVID-19 patient. This architecture aims to be an explainable decision-support triaging system for medical professionals in countries lacking advanced medical technology and infrastructure to reduce fatalities.

Utilizing CNN-LSTM techniques for the enhancement of medical systems

COVID-19 is one of the most chronic and serious infections of recent years due to its worldwide spread. Determining who was genuinely affected when the disease spreads more widely is challenging. More than 60% of affected individuals report having a dry cough. In many recent studies, diagnostic models were developed using coughing and other breathing sounds. With the development of technology, body sounds are now collected using digital techniques for respiratory and cardiovascular tests. Early research on identifying COVID-19 utilizing speech and diagnosing signs yielded encouraging findings. The gathering of extensive, multi-group, airborne acoustical sound data is used in the developed framework to conduct an efficient assessment to test for COVID-19. An effective classification model is created to assess COVID-19 utilizing deep learning methods. The MIT-Covid-19 dataset is used as the input, and the Weiner filter is used for pre-processing. Following feature extraction done by Mel-frequency cepstral coefficients, the classification is performed using the CNN-LSTM approach. The study compared the performance of the developed framework with other techniques such as CNN, GRU, and LSTM. Study results revealed that CNN-LSTM outperformed other existing approaches by 97.7%.

Spatiotemporal transmission of infectious nanochemical particles in water environment: A case study of Covid-19

This study explores the dynamic transmission of nanochemical infectious particles due to COVID-19 in the water environment using a spatiotemporal epidemiological approach. We proposed a novel multi-agent model to simulate the spread of COVID-19 by considering several influencing factors. The model divides the population into susceptible and infected and analyzes the impact of different prevention and control measures, such as limiting the number of people and wearing masks on the spread of COVID-19. The findings suggest that reducing population density and wearing masks can significantly reduce the likelihood of virus transmission. Specifically, the research shows that if the population moves within a fixed range, almost everyone will eventually be infected within 1 h. When the population density is 50%, the infection rate is as high as 96%. If everyone does not wear a mask, nearly 72.33% of the people will be infected after 1 h. However, when people wear masks, the infection rate is consistently lower than when they do not wear masks. Even if only 25% of people wear masks, the infection rate with masks is 27.67% lower than without masks, which is strong evidence of the importance of wearing a mask. As people's daily activities are mostly carried out indoors, and many super-spreading events of the new crown epidemic also originated from indoor gatherings, the research on indoor epidemic prevention and control is essential. This study provides decision-making support for epidemic preventions and controls and the proposed methodology can be used in other regions and future epidemics.

Predicting Mortality in Hospitalized COVID-19 Patients in Zambia: An Application of Machine Learning

The coronavirus disease 2019 (COVID-19) has wreaked havoc globally, resulting in millions of cases and deaths. The objective of this study was to predict mortality in hospitalized COVID-19 patients in Zambia using machine learning (ML) methods based on factors that have been shown to be predictive of mortality and thereby improve pandemic preparedness. This research employed seven powerful ML models that included decision tree (DT), random forest (RF), support vector machines (SVM), logistic regression (LR), Naïve Bayes (NB), gradient boosting (GB), and XGBoost (XGB). These classifiers were trained on 1,433 hospitalized COVID-19 patients from various health facilities in Zambia. The performances achieved by these models were checked using accuracy, recall, F1-Score, area under the receiver operating characteristic curve (ROC_AUC), area under the precision-recall curve (PRC_AUC), and other metrics. The best-performing model was the XGB which had an accuracy of 92.3%, recall of 94.2%, F1-Score of 92.4%, and ROC_AUC of 97.5%. The pairwise Mann-Whitney U-test analysis showed that the second-best model (GB) and the third-best model (RF) did not perform significantly worse than the best model (XGB) and had the following: GB had an accuracy of 91.7%, recall of 94.2%, F1-Score of 91.9%, and ROC_AUC of 97.1%. RF had an accuracy of 90.8%, recall of 93.6%, F1-Score of 91.0%, and ROC_AUC of 96.8%. Other models showed similar results for the same metrics checked. The study successfully derived and validated the selected ML models and predicted mortality effectively with reasonably high performance in the stated metrics. The feature importance analysis found that knowledge of underlying health conditions about patients' hospital length of stay (LOS), white blood cell count, age, and other factors can help healthcare providers offer lifesaving services on time, improve pandemic preparedness, and decongest health facilities in Zambia and other countries with similar settings.

Artificial intelligence and discrete-event simulation for capacity management of intensive care units during the Covid-19 pandemic: A case study

The Covid-19 pandemic has pushed the Intensive Care Units (ICUs) into significant operational disruptions. The rapid evolution of this disease, the bed capacity constraints, the wide variety of patient profiles, and the imbalances within health supply chains still represent a challenge for policymakers. This paper aims to use Artificial Intelligence (AI) and Discrete-Event Simulation (DES) to support ICU bed capacity management during Covid-19. The proposed approach was validated in a Spanish hospital chain where we initially identified the predictors of ICU admission in Covid-19 patients. Second, we applied Random Forest (RF) to predict ICU admission likelihood using patient data collected in the Emergency Department (ED). Finally, we included the RF outcomes in a DES model to assist decision-makers in evaluating new ICU bed configurations responding to the patient transfer expected from downstream services. The results evidenced that the median bed waiting time declined between 32.42 and 48.03 min after intervention.

Predicting the negative conversion time of nonsevere COVID-19 patients using machine learning methods

Based on the patient's clinical characteristics and laboratory indicators, different machine-learning methods were used to develop models for predicting the negative conversion time of nonsevere coronavirus disease 2019 (COVID-19) patients. A retrospective analysis was performed on 376 nonsevere COVID-19 patients admitted to Wuxi Fifth People's Hospital from May 2, 2022, to May 14, 2022. The patients were divided into training set (n = 309) and test set (n = 67). The clinical features and laboratory parameters of the patients were collected. In the training set, the least absolute shrinkage and selection operator (LASSO) was used to select predictive features and train six machine learning models: multiple linear regression (MLR), K-Nearest Neighbors Regression (KNNR), random forest regression (RFR), support vector machine regression (SVR), XGBoost regression (XGBR), and multilayer perceptron regression (MLPR). Seven best predictive features selected by LASSO included: age, gender, vaccination status, IgG, lymphocyte ratio, monocyte ratio, and lymphocyte count. The predictive performance of the models in the test set was MLPR > SVR > MLR > KNNR > XGBR > RFR, and MLPR had the strongest generalization performance, which is significantly better than SVR and MLR. In the MLPR model, vaccination status, IgG, lymphocyte count, and lymphocyte ratio were protective factors for negative conversion time; male gender, age, and monocyte ratio were risk factors. The top three features with the highest weights were vaccination status, gender, and IgG. Machine learning methods (especially MLPR) can effectively predict the negative conversion time of non-severe COVID-19 patients. It can help to rationally allocate limited medical resources and prevent disease transmission, especially during the Omicron pandemic.

Artificial Intelligence Functionalities During the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led us to use virtual solutions and emerging technologies such as artificial intelligence (AI). Recent studies have clearly demonstrated the role of AI in health care and medical practice; however, a comprehensive review can identify potential yet not fulfilled functionalities of such technologies in pandemics. Therefore, this scoping review study aims at assessing AI functionalities in the COVID-19 pandemic in 2022.

METHODS

A systematic search was carried out in PubMed, Cochran Library, Scopus, Science Direct, ProQuest, and Web of Science from 2019 to May 9, 2022. Researchers selected the articles according to the search keywords. Finally, the articles mentioning the functionalities of AI in the COVID-19 pandemic were evaluated. Two investigators performed this process.

RESULTS

Initial search resulted in 9123 articles. After reviewing the title, abstract, and full text of these articles, and applying the inclusion and exclusion criteria, 4 articles were selectd for the final analysis. All 4 were cross-sectional studies. Two studies (50%) were performed in the United States, 1 (25%) in Israel, and 1 (25%) in Saudi Arabia. They covered the functionalities of AI in the prediction, detection, and diagnosis of COVID-19.

CONCLUSIONS

To the extent of the researchers' knowledge, this study is the first scoping review that assesses the AI functionalities in the COVID-19 pandemic. Health-care organizations need decision support technologies and evidence-based apparatuses that can perceive, think, and reason not dissimilar to human beings. Potential functionalities of such technologies can be used to predict mortality, detect, screen, and trace current and former patients, analyze health data, prioritize high-risk patients, and better allocate hospital resources in pandemics, and generally in health-care settings.

A Review of the Machine Learning Algorithms for Covid-19 Case Analysis

The purpose of this article is to see how machine learning (ML) algorithms and applications are used in the COVID-19 inquiry and for other purposes. The available traditional methods for COVID-19 international epidemic prediction, researchers and authorities have given more attention to simple statistical and epidemiological methodologies. The inadequacy and absence of medical testing for diagnosing and identifying a solution is one of the key challenges in preventing the spread of COVID-19. A few statistical-based improvements are being strengthened to answer this challenge, resulting in a partial resolution up to a certain level. ML have advocated a wide range of intelligence-based approaches, frameworks, and equipment to cope with the issues of the medical industry. The application of inventive structure, such as ML and other in handling COVID-19 relevant outbreak difficulties, has been investigated in this article. The major goal of this article is to 1) Examining the impact of the data type and data nature, as well as obstacles in data processing for COVID-19. 2) Better grasp the importance of intelligent approaches like ML for the COVID-19 pandemic. 3) The development of improved ML algorithms and types of ML for COVID-19 prognosis. 4) Examining the effectiveness and influence of various strategies in COVID-19 pandemic. 5) To target on certain potential issues in COVID-19 diagnosis in order to motivate academics to innovate and expand their knowledge and research into additional COVID-19-affected industries.

Predicting intubation risk among COVID-19 hospitalized patients using artificial neural networks

BACKGROUND

Accurately predicting the intubation risk in COVID-19 patients at the admission time is critical to optimal use of limited hospital resources, providing customized and evidence-based treatments, and improving the quality of delivered medical care services. This study aimed to design a statistical algorithm to select the best features influencing intubation prediction in coronavirus disease 2019 (COVID-19) hospitalized patients. Then, using selected features, multiple artificial neural network (ANN) configurations were developed to predict intubation risk.

MATERIAL AND METHODS

In this retrospective single-center study, a dataset containing 482 COVID-19 patients who were hospitalized between February 9, 2020 and July 20, 2021 was used. First, the Phi correlation coefficient method was performed for selecting the most important features affecting COVID-19 patients' intubation. Then, the different configurations of ANN were developed. Finally, the performance of ANN configurations was assessed using several evaluation metrics, and the best structure was determined for predicting intubation requirements among hospitalized COVID-19 patients.

RESULTS

The ANN models were developed based on 18 validated features. The results indicated that the best performance belongs to the 18-20-1 ANN configuration with positive predictive value (PPV) = 0.907, negative predictive value (NPV) = 0.941, sensitivity = 0.898, specificity = 0.951, and area under curve (AUC) = 0.906.

CONCLUSIONS

The results demonstrate the effectiveness of the ANN models for timely and reliable prediction of intubation risk in COVID-19 hospitalized patients. Our models can inform clinicians and those involved in policymaking and decision making for prioritizing restricted mechanical ventilation and other related resources for critically COVID-19 patients.

SARS-CoV-2 Diagnosis Using Transcriptome Data: A Machine Learning Approach

SARS-CoV-2 pandemic is the big issue of the whole world right now. The health community is struggling to rescue the public and countries from this spread, which revives time to time with different waves. Even the vaccination seems to be not prevents this spread. Accurate identification of infected people on time is essential these days to control the spread. So far, Polymerase chain reaction (PCR) and rapid antigen tests are widely used in this identification, accepting their own drawbacks. False negative cases are the menaces in this scenario. To avoid these problems, this study uses machine learning techniques to build a classification model with higher accuracy to filter the COVID-19 cases from the non-COVID individuals. Transcriptome data of the SARS-CoV-2 patients along with the control are used in this stratification using three different feature selection algorithms and seven classification models. Differently expressed genes also studied between these two groups of people and used in this classification. Results shows that mutual information (or DEGs) along with naïve Bayes (or SVM) gives the best accuracy (0.98 ± 0.04) among these methods.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42979-023-01703-6.

Prediction of mortality risk and duration of hospitalization of COVID-19 patients with chronic comorbidities based on machine learning algorithms

Background

The severity of coronavirus (COVID-19) in patients with chronic comorbidities is much higher than in other patients, which can lead to their death. Machine learning (ML) algorithms as a potential solution for rapid and early clinical evaluation of the severity of the disease can help in allocating and prioritizing resources to reduce mortality.

Objective

The objective of this study was to predict the mortality risk and length of stay (LoS) of patients with COVID-19 and history of chronic comorbidities using ML algorithms.

Methods

This retrospective study was conducted by reviewing the medical records of COVID-19 patients with a history of chronic comorbidities from March 2020 to January 2021 in Afzalipour Hospital in Kerman, Iran. The outcome of patients, hospitalization was recorded as discharge or death. The filtering technique used to score the features and well-known ML algorithms were applied to predict the risk of mortality and LoS of patients. Ensemble Learning methods is also used. To evaluate the performance of the models, different measures including F1, precision, recall, and accuracy were calculated. The TRIPOD guideline assessed transparent reporting.

Results

This study was performed on 1291 patients, including 900 alive and 391 dead patients. Shortness of breath (53.6%), fever (30.1%), and cough (25.3%) were the three most common symptoms in patients. Diabetes mellitus(DM) (31.3%), hypertension (HTN) (27.3%), and ischemic heart disease (IHD) (14.2%) were the three most common chronic comorbidities of patients. Twenty-six important factors were extracted from each patient's record. Gradient boosting model with 84.15% accuracy was the best model for predicting mortality risk and multilayer perceptron (MLP) with rectified linear unit function (MSE = 38.96) was the best model for predicting the LoS. The most common chronic comorbidities among these patients were DM (31.3%), HTN (27.3%), and IHD (14.2%). The most important factors in predicting the risk of mortality were hyperlipidemia, diabetes, asthma, and cancer, and in predicting LoS was shortness of breath.

Conclusion

The results of this study showed that the use of ML algorithms can be a good tool to predict the risk of mortality and LoS of patients with COVID-19 and chronic comorbidities based on physiological conditions, symptoms, and demographic information of patients. The Gradient boosting and MLP algorithms can quickly identify patients at risk of death or long-term hospitalization and notify physicians to do appropriate interventions.

Coronavirus disease (COVID-19) cases analysis using machine-learning applications

Today world thinks about coronavirus disease that which means all even this pandemic disease is not unique. The purpose of this study is to detect the role of machine-learning applications and algorithms in investigating and various purposes that deals with COVID-19. Review of the studies that had been published during 2020 and were related to this topic by seeking in Science Direct, Springer, Hindawi, and MDPI using COVID-19, machine learning, supervised learning, and unsupervised learning as keywords. The total articles obtained were 16,306 overall but after limitation; only 14 researches of these articles were included in this study. Our findings show that machine learning can produce an important role in COVID-19 investigations, prediction, and discrimination. In conclusion, machine learning can be involved in the health provider programs and plans to assess and triage the COVID-19 cases. Supervised learning showed better results than other Unsupervised learning algorithms by having 92.9% testing accuracy. In the future recurrent supervised learning can be utilized for superior accuracy.

A comparison of machine learning algorithms in predicting COVID-19 prognostics

ML algorithms are used to develop prognostic and diagnostic models and so to support clinical decision-making. This study uses eight supervised ML algorithms to predict the need for intensive care, intubation, and mortality risk for COVID-19 patients. The study uses two datasets: (1) patient demographics and clinical data (n = 11,712), and (2) patient demographics, clinical data, and blood test results (n = 602) for developing the prediction models, understanding the most significant features, and comparing the performances of eight different ML algorithms. Experimental findings showed that all prognostic prediction models reported an AUROC value of over 0.92, in which extra tree and CatBoost classifiers were often outperformed (AUROC over 0.94). The findings revealed that the features of C-reactive protein, the ratio of lymphocytes, lactic acid, and serum calcium have a substantial impact on COVID-19 prognostic predictions. This study provides evidence of the value of tree-based supervised ML algorithms for predicting prognosis in health care.

Prognostic significance of chest CT severity score in mortality prediction of COVID-19 patients, a machine learning study

Background

The high mortality rate of COVID-19 makes it necessary to seek early identification of high-risk patients with poor prognoses. Although the association between CT-SS and mortality of COVID-19 patients was reported, its prognosis significance in combination with other prognostic parameters was not evaluated yet.

Methods

This retrospective single-center study reviewed a total of 6854 suspected patients referred to Imam Khomeini hospital, Ilam city, west of Iran, from February 9, 2020 to December 20, 2020. The prognostic performances of k-Nearest Neighbors (kNN), Multilayer Perceptron (MLP), Support Vector Machine (SVM), and J48 decision tree algorithms were evaluated based on the most important and relevant predictors. The metrics derived from the confusion matrix were used to determine the performance of the ML models.

Results

After applying exclusion criteria, 815 hospitalized cases were entered into the study. Of these, 447(54.85%) were male and the mean (± SD) age of participants was 57.22(± 16.76) years. The results showed that the performances of the ML algorithms were improved when they are fed by the dataset with CT-SS data. The kNN model with an accuracy of 94.1%, sensitivity of 100. 0%, precision of 89.5%, specificity of 88.3%, and AUC around 97.2% had the best performance among the other three ML techniques.

Conclusions

The integration of CT-SS data with demographics, risk factors, clinical manifestations, and laboratory parameters improved the prognostic performances of the ML algorithms. An ML model with a comprehensive collection of predictors could identify high-risk patients more efficiently and lead to the optimal use of hospital resources.

Biserial targeted feature projection based radial kernel regressive deep belief neural learning for covid-19 prediction

Coronavirus disease 2019 (COVID-19) is a highly infectious viral disease caused by the novel SARS-CoV-2 virus. Different prediction techniques have been developed to predict the coronavirus disease's existence in patients. However, the accurate prediction was not improved and time consumption was not minimized. In order to address these existing problems, a novel technique called Biserial Targeted Feature Projection-based Radial Kernel Regressive Deep Belief Neural Learning (BTFP-RKRDBNL) is introduced to perform accurate disease prediction with lesser time consumption. The BTFP-RKRDBNL techniques perform disease prediction with the help of different layers such as two visible layers namely input and layer and two hidden layers. Initially, the features and data are collected from the dataset and transmitted to the input layer. The Point Biserial Correlative Target feature projection is used to select relevant features and other irrelevant features are removed with minimizing the disease prediction time. Then the relevant features are sent to the hidden layer 2. Next, Radial Kernel Regression is applied to analyze the training features and testing disease features to identify the disease with higher accuracy and a lesser false positive rate. Experimental analysis is planned to measure the prediction accuracy, sensitivity, and specificity, and prediction time for different numbers of patients. The result illustrates that the method increases the prediction accuracy, sensitivity, and specificity by 10, 6, and 21% and reduces the prediction time by 10% as compared to state-of-the-art works.

Artificial intelligence-based model for COVID-19 prognosis incorporating chest radiographs and clinical data; a retrospective model development and validation study

OBJECTIVES

The purpose of this study was to develop an artificial intelligence-based model to prognosticate COVID-19 patients at admission by combining clinical data and chest radiographs.

METHODS

This retrospective study used the Stony Brook University COVID-19 dataset of 1384 inpatients. After exclusions, 1356 patients were randomly divided into training (1083) and test datasets (273). We implemented three artificial intelligence models, which classified mortality, ICU admission, or ventilation risk. Each model had three submodels with different inputs: clinical data, chest radiographs, and both. We showed the importance of the variables using SHapley Additive exPlanations (SHAP) values.

RESULTS

The mortality prediction model was best overall with area under the curve, sensitivity, specificity, and accuracy of 0.79 (0.72-0.86), 0.74 (0.68-0.79), 0.77 (0.61-0.88), and 0.74 (0.69-0.79) for the clinical data-based model; 0.77 (0.69-0.85), 0.67 (0.61-0.73), 0.81 (0.67-0.92), 0.70 (0.64-0.75) for the image-based model, and 0.86 (0.81-0.91), 0.76 (0.70-0.81), 0.77 (0.61-0.88), 0.76 (0.70-0.81) for the mixed model. The mixed model had the best performance (p value < 0.05). The radiographs ranked fourth for prognostication overall, and first of the inpatient tests assessed.

CONCLUSIONS

These results suggest that prognosis models become more accurate if AI-derived chest radiograph features and clinical data are used together.

ADVANCES IN KNOWLEDGE

This AI model evaluates chest radiographs together with clinical data in order to classify patients as having high or low mortality risk. This work shows that chest radiographs taken at admission have significant COVID-19 prognostic information compared to clinical data other than age and sex.

Prognostic Model of COVID-19 Severity and Survival among Hospitalized Patients Using Machine Learning Techniques

We conducted a statistical study and developed a machine learning model to triage COVID-19 patients affected during the height of the COVID-19 pandemic in Hong Kong based on their medical records and test results (features) collected during their hospitalization. The correlation between the values of these features is studied against discharge status and disease severity as a preliminary step to identify those features with a more pronounced effect on the patient outcome. Once identified, they constitute the inputs of four machine learning models, Decision Tree, Random Forest, Gradient and RUSBoosting, which predict both the Mortality and Severity associated with the disease. We test the accuracy of the models when the number of input features is varied, demonstrating their stability; i.e., the models are already highly predictive when run over a core set of (6) features. We show that Random Forest and Gradient Boosting classifiers are highly accurate in predicting patients' Mortality (average accuracy ∼99%) as well as categorize patients (average accuracy ∼91%) into four distinct risk classes (Severity of COVID-19 infection). Our methodical and broad approach combines statistical insights with various machine learning models, which paves the way forward in the AI-assisted triage and prognosis of COVID-19 cases, which is potentially generalizable to other seasonal flus.

A Catalogue of Machine Learning Algorithms for Healthcare Risk Predictions

Extracting useful knowledge from proper data analysis is a very challenging task for efficient and timely decision-making. To achieve this, there exist a plethora of machine learning (ML) algorithms, while, especially in healthcare, this complexity increases due to the domain's requirements for analytics-based risk predictions. This manuscript proposes a data analysis mechanism experimented in diverse healthcare scenarios, towards constructing a catalogue of the most efficient ML algorithms to be used depending on the healthcare scenario's requirements and datasets, for efficiently predicting the onset of a disease. To this context, seven (7) different ML algorithms (Naïve Bayes, K-Nearest Neighbors, Decision Tree, Logistic Regression, Random Forest, Neural Networks, Stochastic Gradient Descent) have been executed on top of diverse healthcare scenarios (stroke, COVID-19, diabetes, breast cancer, kidney disease, heart failure). Based on a variety of performance metrics (accuracy, recall, precision, F1-score, specificity, confusion matrix), it has been identified that a sub-set of ML algorithms are more efficient for timely predictions under specific healthcare scenarios, and that is why the envisioned ML catalogue prioritizes the ML algorithms to be used, depending on the scenarios' nature and needed metrics. Further evaluation must be performed considering additional scenarios, involving state-of-the-art techniques (e.g., cloud deployment, federated ML) for improving the mechanism's efficiency.

COVID-19 machine learning model predicts outcomes in older patients from various European countries, between pandemic waves, and in a cohort of Asian, African, and American patients

BACKGROUND

COVID-19 remains a complex disease in terms of its trajectory and the diversity of outcomes rendering disease management and clinical resource allocation challenging. Varying symptomatology in older patients as well as limitation of clinical scoring systems have created the need for more objective and consistent methods to aid clinical decision making. In this regard, machine learning methods have been shown to enhance prognostication, while improving consistency. However, current machine learning approaches have been limited by lack of generalisation to diverse patient populations, between patients admitted at different waves and small sample sizes.

OBJECTIVES

We sought to investigate whether machine learning models, derived on routinely collected clinical data, can generalise well i) between European countries, ii) between European patients admitted at different COVID-19 waves, and iii) between geographically diverse patients, namely whether a model derived on the European patient cohort can be used to predict outcomes of patients admitted to Asian, African and American ICUs.

METHODS

We compare Logistic Regression, Feed Forward Neural Network and XGBoost algorithms to analyse data from 3,933 older patients with a confirmed COVID-19 diagnosis in predicting three outcomes, namely: ICU mortality, 30-day mortality and patients at low risk of deterioration. The patients were admitted to ICUs located in 37 countries, between January 11, 2020, and April 27, 2021.

RESULTS

The XGBoost model derived on the European cohort and externally validated in cohorts of Asian, African, and American patients, achieved AUC of 0.89 (95% CI 0.89-0.89) in predicting ICU mortality, AUC of 0.86 (95% CI 0.86-0.86) for 30-day mortality prediction and AUC of 0.86 (95% CI 0.86-0.86) in predicting low-risk patients. Similar AUC performance was achieved also when predicting outcomes between European countries and between pandemic waves, while the models showed high calibration quality. Furthermore, saliency analysis showed that FiO2 values of up to 40% do not appear to increase the predicted risk of ICU and 30-day mortality, while PaO2 values of 75 mmHg or lower are associated with a sharp increase in the predicted risk of ICU and 30-day mortality. Lastly, increase in SOFA scores also increase the predicted risk, but only up to a value of 8. Beyond these scores the predicted risk remains consistently high.

CONCLUSION

The models captured both the dynamic course of the disease as well as similarities and differences between the diverse patient cohorts, enabling prediction of disease severity, identification of low-risk patients and potentially supporting effective planning of essential clinical resources.

TRIAL REGISTRATION NUMBER

NCT04321265.

Predictive models for COVID-19 detection using routine blood tests and machine learning

The problem of accurate, fast, and inexpensive COVID-19 tests has been urgent till now. Standard COVID-19 tests need high-cost reagents and specialized laboratories with high safety requirements, are time-consuming. Data of routine blood tests as a base of SARS-CoV-2 invasion detection allows using the most practical medicine facilities. But blood tests give general information about a patient’s state, which is not directly associated with COVID-19. COVID-19-specific features should be selected from the list of standard blood characteristics, and decision-making software based on appropriate clinical data should be created. This review describes the abilities to develop predictive models for COVID-19 detection using routine blood tests and machine learning.

Direct Detection of Glycated Human Serum Albumin and Hyperglycosylated IgG3 in Serum, by MALDI-ToF Mass Spectrometry, as a Predictor of COVID-19 Severity

The prefusion spike protein of SARS-CoV-2 binds advanced glycation end product (AGE)-glycated human serum albumin (HSA) and a higher mass (hyperglycosylated/glycated) immunoglobulin (Ig) G3, as determined by matrix assisted laser desorption mass spectrometry (MALDI-ToF). We set out to investigate if the total blood plasma of patients who had recovered from acute respiratory distress syndrome (ARDS) as a result of COVID-19, contained more glycated HSA and higher mass (glycosylated/glycated) IgG3 than those with only clinically mild or asymptomatic infections. A direct serum dilution, and disulphide bond reduction, method was developed and applied to plasma samples from SARS-CoV-2 seronegative (n = 30) and seropositive (n = 31) healthcare workers (HCWs) and 38 convalescent plasma samples from patients who had been admitted with acute respiratory distress (ARDS) associated with COVID-19. Patients recovering from COVID-19 ARDS had significantly higher mass AGE-glycated HSA and higher mass IgG3 levels. This would indicate that increased levels and/or ratios of hyper-glycosylation (probably terminal sialic acid) IgG3 and AGE glycated HSA may be predisposition markers for the development of COVID-19 ARDS as a result of SARS-CoV2 infection. Furthermore, rapid direct analysis of serum/plasma samples by MALDI-ToF for such humoral immune correlates of COVID-19 presents a feasible screening technology for the most at risk; regardless of age or known health conditions.

Neural-Symbolic Ensemble Learning for early-stage prediction of critical state of Covid-19 patients

Recently, Artificial Intelligence (AI) and Machine Learning (ML) have been successfully applied to many domains of interest including medical diagnosis. Due to the availability of a large quantity of data, it is possible to build reliable AI systems that assist humans in making decisions. The recent Covid-19 pandemic quickly spread over the world causing serious health problems and severe economic and social damage. Computer scientists are actively working together with doctors on different ML models to diagnose Covid-19 patients using Computed Tomography (CT) scans and clinical data. In this work, we propose a neural-symbolic system that predicts if a Covid-19 patient arriving at the hospital will end in a critical condition. The proposed system relies on Deep 3D Convolutional Neural Networks (3D-CNNs) for analyzing lung CT scans of Covid-19 patients, Decision Trees (DTs) for predicting if a Covid-19 patient will eventually pass away by analyzing its clinical data, and a neural system that integrates the previous ones using Hierarchical Probabilistic Logic Programs (HPLPs). Predicting if a Covid-19 patient will end in a critical condition is useful for managing the limited number of intensive care at the hospital. Moreover, knowing early that a Covid-19 patient could end in serious conditions allows doctors to gain early knowledge on patients and provide special treatment to those predicted to finish in critical conditions. The proposed system, entitled Neural HPLP, obtains good performance in terms of area under the receiver operating characteristic and precision curves with values of about 0.96 for both metrics. Therefore, with Neural HPLP, it is possible not only to efficiently predict if Covid-19 patients will end in severe conditions but also possible to provide an explanation of the prediction. This makes Neural HPLP explainable, interpretable, and reliable.

Graphical abstract

Violation of expectations is correlated with satisfaction following hip arthroscopy

PURPOSE

The mechanism by which preoperative expectations may be associated with patient satisfaction and procedural outcomes following hip preservation surgery (HPS) is far from simple or linear. The purpose of this study is to better understand patient expectations regarding HPS and their relationship with patient-reported outcomes (PROs) and satisfaction using machine learning (ML) algorithms.

METHODS

Patients scheduled for hip arthroscopy completed the Hip Preservation Surgery Expectations Survey (HPSES) and the pre- and a minimum 2 year postoperative International Hip Outcome Tool (iHOT-33). Patient demographics, including age, gender, occupation, and body mass index (BMI), were also collected. At the latest follow-up, patients were evaluated for subjective satisfaction and postoperative complications. ML algorithms and standard statistics were used.

RESULTS

A total of 69 patients were included in this study (mean age 33.7 ± 13.1 years, 62.3% males). The mean follow-up period was 27 months. The mean HPSES score, patient satisfaction, preoperative, and postoperative iHOT-33 were 83.8 ± 16.5, 75.9 ± 26.9, 31.6 ± 15.8, and 73 ± 25.9, respectively. Fifty-nine patients (86%) reported that they would undergo the surgery again, with no significant difference with regards to expectations. A significant difference was found with regards to expectation violation (p < 0.001). Expectation violation scores were also found to be significantly correlated with satisfaction.

CONCLUSION

ML algorithms utilized in this study demonstrate that violation of expectations plays an important predictive role in postoperative outcomes and patient satisfaction and is associated with patients' willingness to undergo surgery again.

LEVEL OF EVIDENCE

IV.

Machine learning techniques for CT imaging diagnosis of novel coronavirus pneumonia: a review

Since 2020, novel coronavirus pneumonia has been spreading rapidly around the world, bringing tremendous pressure on medical diagnosis and treatment for hospitals. Medical imaging methods, such as computed tomography (CT), play a crucial role in diagnosing and treating COVID-19. A large number of CT images (with large volume) are produced during the CT-based medical diagnosis. In such a situation, the diagnostic judgement by human eyes on the thousands of CT images is inefficient and time-consuming. Recently, in order to improve diagnostic efficiency, the machine learning technology is being widely used in computer-aided diagnosis and treatment systems (i.e., CT Imaging) to help doctors perform accurate analysis and provide them with effective diagnostic decision support. In this paper, we comprehensively review these frequently used machine learning methods applied in the CT Imaging Diagnosis for the COVID-19, discuss the machine learning-based applications from the various kinds of aspects including the image acquisition and pre-processing, image segmentation, quantitative analysis and diagnosis, and disease follow-up and prognosis. Moreover, we also discuss the limitations of the up-to-date machine learning technology in the context of CT imaging computer-aided diagnosis.

Prediction of hospital mortality in intensive care unit patients from clinical and laboratory data: A machine learning approach

BACKGROUND

Intensive care unit (ICU) patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making. Those data are vital in the assistance of these patients, being already used by several scoring systems. In this context, machine learning approaches have been used for medical predictions based on clinical data, which includes patient outcomes.

AIM

To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters, a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the “WiDS (Women in Data Science) Datathon 2020: ICU Mortality Prediction” dataset.

METHODS

For categorical variables, frequencies and risk ratios were calculated. Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed. We then divided the data into a training (80%) and test (20%) set. The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.

RESULTS

A statistically significant association was identified between need for intubation, as well predominant systemic cardiovascular involvement, and hospital death. A number of the numerical variables analyzed (for instance Glasgow Coma Score punctuations, mean arterial pressure, temperature, pH, and lactate, creatinine, albumin and bilirubin values) were also significantly associated with death outcome. The proposed binary Random Forest classifier obtained on the test set (n = 218) had an accuracy of 80.28%, sensitivity of 81.82%, specificity of 79.43%, positive predictive value of 73.26%, negative predictive value of 84.85%, F1 score of 0.74, and area under the curve score of 0.85. The predictive variables of the greatest importance were the maximum and minimum lactate values, adding up to a predictive importance of 15.54%.

CONCLUSION

We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring. Therefore, we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies, allowing improvements that reduce mortality.

Weather Conditions and COVID-19 Cases: Insights from the GCC Countries

The prediction of new COVID-19 cases is crucial for decision makers in many countries. Researchers are continually proposing new models to forecast the future tendencies of this pandemic, among which long short-term memory (LSTM) artificial neural networks have exhibited relative superiority compared to other forecasting techniques. Moreover, the correlation between the spread of COVID-19 and exogenous factors, specifically weather features, has been explored to improve forecasting models. However, contradictory results have been reported regarding the incorporation of weather features into COVID-19 forecasting models. Therefore, this study compares uni-variate with bi- and multi-variate LSTM forecasting models for predicting COVID-19 cases, among which the latter models consider weather features. LSTM models were used to forecast COVID-19 cases in the six Gulf Cooperation Council countries. The root mean square error (RMSE) and coefficient of determination (R2) were employed to measure the accuracy of the LSTM forecasting models. Despite similar weather conditions, the weather features that exhibited the strongest correlation with COVID-19 cases differed among the six countries. Moreover, according to the statistical comparisons that were conducted, the improvements gained by including weather features were insignificant in terms of the RMSE values and marginally significant in terms of the R2 values. Consequently, it is concluded that the uni-variate LSTM models were as good as the best bi- and multi-variate LSTM models; therefore, weather features need not be included. Furthermore, we could not identify a single weather feature that can consistently improve the forecasting accuracy.

Predicting the Need for Intubation among COVID-19 Patients Using Machine Learning Algorithms: A Single-Center Study

Background: Owing to the shortage of ventilators, there is a crucial demand for an objective and accurate prognosis for 2019 coronavirus disease (COVID-19) critical patients, which may necessitate a mechanical ventilator (MV). This study aimed to construct a predictive model using machine learning (ML) algorithms for frontline clinicians to better triage endangered patients and priorities who would need MV.

Methods: In this retrospective single-center study, the data of 482 COVID-19 patients from February 9, 2020, to December 20, 2020, were analyzed by several ML algorithms including, multi-layer perception (MLP), logistic regression (LR), J-48 decision tree, and Naïve Bayes (NB). First, the most important clinical variables were identified using the Chi-square test at P < 0.01. Then, by comparing the ML algorithms' performance using some evaluation criteria, including TP-Rate, FP-Rate, precision, recall, F-Score, MCC, and Kappa, the best performing one was identified.

Results: Predictive models were trained using 15 validated features, including cough, contusion, oxygen therapy, dyspnea, loss of taste, rhinorrhea, blood pressure, absolute lymphocyte count, pleural fluid, activated partial thromboplastin time, blood glucose, white cell count, cardiac diseases, length of hospitalization, and other underline diseases. The results indicated the J-48 with F-score = 0.868 and AUC = 0.892 yielded the best performance for predicting intubation requirement.

Conclusion: ML algorithms are potentials to improve traditional clinical criteria to forecast the necessity for intubation in COVID-19 in-hospital patients. Such ML-based prediction models may help physicians with optimizing the timing of intubation, better sharing of MV resources and personnel, and increase patient clinical status.

Identifying the High-Risk Population for COVID-19 Transmission in Hong Kong Leveraging Explainable Machine Learning

The worldwide spread of COVID-19 has caused significant damage to people’s health and economics. Many works have leveraged machine learning models to facilitate the control and treatment of COVID-19. However, most of them focus on clinical medicine and few on understanding the spatial dynamics of the high-risk population for transmission of COVID-19 in real-world settings. This study aims to investigate the association between population features and COVID-19 transmission risk in Hong Kong, which can help guide the allocation of medical resources and the implementation of preventative measures to control the spread of the pandemic. First, we built machine learning models to predict the number of COVID-19 cases based on the population features of different tertiary planning units (TPUs). Then, we analyzed the distribution of cases and the prediction results to find specific characteristics of TPUs leading to large-scale outbreaks of COVID-19. We further evaluated the importance and influence of various population features on the prediction results using SHAP values to identify indicators for high-risk populations for COVID-19 transmission. The evaluation of COVID-19 cases and the TPU dataset in Hong Kong shows the effectiveness of the proposed methods. The top three most important indicators are identified as people in accommodation and food services, low income, and high population density.

Risk assessment in COVID-19 patients: A multiclass classification approach

Understanding SARS-CoV-2 infection that causes COVID-19 disease among the population was fundamental to determine the risk factors associated with severe cases or even death. Amidst the study of the pandemic, Artificial Intelligence (AI) and Machine Learning (ML) have been successfully applied in many areas such as biomedicine. Using a dataset from the Mexican Ministry of Health, we performed a multiclass classification scheme for the detection of risks in COVID-19 patients and implemented three Machine Learning algorithms achieving the following accuracy measures: Random Forest (89.86%), GBM (89.37%) XGBoost (89.97%). The key findings are the identification of relevant components associated with different severities of COVID-19 disease. Among these factors, we found sex, age, days elapsed from the beginning of symptoms, symptoms such as dyspnea and polypnea; and other comorbidities such as diabetes and hypertension. This setting allows us to establish predicting algorithms to model the risk that an individual or a specific group of people face after contracting COVID-19 and the factors associated with developing complications or receiving appropriate treatment.

Analyzing the research trends of COVID-19 using topic modeling approach

Purpose

The COVID-19 pandemic has impacted 222 countries across the globe, with millions of people losing their lives. The threat from the virus may be assessed from the fact that most countries across the world have been forced to order partial or complete shutdown of their economies for a period of time to contain the spread of the virus. The fallout of this action manifested in loss of livelihood, migration of the labor force and severe impact on mental health due to the long duration of confinement to homes or residences.

Design/methodology/approach

The current study identifies the focus areas of the research conducted on the COVID-19 pandemic. Abstracts of papers on the subject were collated from the SCOPUS database for the period December 2019 to June 2020. The collected sample data (after preprocessing) was analyzed using Topic Modeling with Latent Dirichlet Allocation.

Findings

Based on the research papers published within the mentioned timeframe, the study identifies the 10 most prominent topics that formed the area of interest for the COVID-19 pandemic research.

Originality/value

While similar studies exist, no other work has used topic modeling to comprehensively analyze the COVID-19 literature by considering diverse fields and domains.

Diagnosis and prognosis of COVID-19 employing analysis of patients' plasma and serum via LC-MS and machine learning

OBJECTIVE

To implement and evaluate machine learning (ML) algorithms for the prediction of COVID-19 diagnosis, severity, and fatality and to assess biomarkers potentially associated with these outcomes.

MATERIAL AND METHODS

Serum (n = 96) and plasma (n = 96) samples from patients with COVID-19 (acute, severe and fatal illness) from two independent hospitals in China were analyzed by LC-MS. Samples from healthy volunteers and from patients with pneumonia caused by other viruses (i.e. negative RT-PCR for COVID-19) were used as controls. Seven different ML-based models were built: PLS-DA, ANNDA, XGBoostDA, SIMCA, SVM, LREG and KNN.

RESULTS

The PLS-DA model presented the best performance for both datasets, with accuracy rates to predict the diagnosis, severity and fatality of COVID-19 of 93%, 94% and 97%, respectively. Low levels of the metabolites ribothymidine, 4-hydroxyphenylacetoylcarnitine and uridine were associated with COVID-19 positivity, whereas high levels of N-acetyl-glucosamine-1-phosphate, cysteinylglycine, methyl isobutyrate, l-ornithine and 5,6-dihydro-5-methyluracil were significantly related to greater severity and fatality from COVID-19.

CONCLUSION

The PLS-DA model can help to predict SARS-CoV-2 diagnosis, severity and fatality in daily practice. Some biomarkers typically increased in COVID-19 patients' serum or plasma (i.e. ribothymidine, N-acetyl-glucosamine-1-phosphate, l-ornithine, 5,6-dihydro-5-methyluracil) should be further evaluated as prognostic indicators of the disease.

Decoding clinical biomarker space of COVID-19: Exploring matrix factorization-based feature selection methods

One of the most critical challenges in managing complex diseases like COVID-19 is to establish an intelligent triage system that can optimize the clinical decision-making at the time of a global pandemic. The clinical presentation and patients' characteristics are usually utilized to identify those patients who need more critical care. However, the clinical evidence shows an unmet need to determine more accurate and optimal clinical biomarkers to triage patients under a condition like the COVID-19 crisis. Here we have presented a machine learning approach to find a group of clinical indicators from the blood tests of a set of COVID-19 patients that are predictive of poor prognosis and morbidity. Our approach consists of two interconnected schemes: Feature Selection and Prognosis Classification. The former is based on different Matrix Factorization (MF)-based methods, and the latter is performed using Random Forest algorithm. Our model reveals that Arterial Blood Gas (ABG) O₂ Saturation and C-Reactive Protein (CRP) are the most important clinical biomarkers determining the poor prognosis in these patients. Our approach paves the path of building quantitative and optimized clinical management systems for COVID-19 and similar diseases.

ISW-LM: An intensive symptom weight learning mechanism for early COVID-19 diagnosis

The novel coronavirus disease 2019 (COVID-19) pandemic has severely impacted the world. The early diagnosis of COVID-19 and self-isolation can help curb the spread of the virus. Besides, a simple and accurate diagnostic method can help in making rapid decisions for the treatment and isolation of patients. The analysis of patient characteristics, case trajectory, comorbidities, symptoms, diagnosis, and outcomes will be performed in the model. In this paper, a symptom-based machine learning (ML) model with a new learning mechanism called Intensive Symptom Weight Learning Mechanism (ISW-LM) is proposed. The proposed model designs three new symptoms' weight functions to identify the most relevant symptoms used to diagnose and classify COVID-19. To verify the efficiency of the proposed model, multiple laboratory and clinical datasets containing epidemiological symptoms and blood tests are used. Experiments indicate that the importance of COVID-19 infection symptoms varies between countries and regions. In most datasets, the most frequent and significant predictive symptoms for diagnosing COVID-19 are fever, sore throat, and cough. The experiment also compares the state-of-the-art methods with the proposed method, which shows that the proposed model has a high accuracy rate of up to 97.1711%. The positive results indicate that the proposed learning mechanism can help clinicians quickly diagnose and screen patients for COVID-19 at an early stage.

Rule Extraction for Screening of COVID-19 Disease Using Granular Computing Approach

In the epidemic status of an unknown virus called Coronavirus, one of the main problems is inadequate access to treatment centers. Statistics show that many people are infected with the virus through unseasonable visits to medical centers immediately after noticing the initial symptoms similar to those reported for Coronavirus. Besides, unnecessary congestion at health centers reduces the quality of service to patients in urgent need of care. Since any external factor, including the virus, appears to have some symptoms after the onset of activity in the affected person, early diagnosis is possible. This paper presents an approach to classifying patients and diagnosing disease by symptoms, based on granular computing. One of the vital features of this method is the extraction of correct rules with zero entropy. This process is done based on a predefined classification of training datasets collected by experts. Granular computing has been a helpful approach in rule extraction and variety in recent years. Experimental results show that the proposed method can successfully detect COVID-19 disease according to its observed symptoms.