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Du Z, Li F, Wang T. Critical care in older adults: Research landscape and hotspots from a bibliometric perspective. Medicine (Baltimore) 2024; 103:e39754. [PMID: 39312337 PMCID: PMC11419464 DOI: 10.1097/md.0000000000039754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024] Open
Abstract
As the population ages, there will be an increasing demand for health care resources, particularly in intensive care. Therefore, critically ill older adults are receiving increasing attention and have been extensively studied. However, the research landscape, dynamic patterns, and emerging topics in this area have scarcely been reviewed. This study aimed to delve into the current status and emerging trends (publication volume and research topics) in critical care for older adults (including interventions, outcomes, and complications) using bibliometric analysis. We retrieved original articles and reviews focusing on critical care for older adults published between 2013 and 2022 from the Web of Science core database. To examine and present the research trends, we employed VOSviewer and CiteSpace software for analysis and visualization. The cooperative network of countries and institutions, cocited authorship network, cocited references, and cooccurrence network of keywords were analyzed. Overall, 6356 articles and reviews published between 2013 and 2022 were analyzed, revealing a noticeable upward trend in the number of publications focused on critical care for older adults. In total, 34,654 authors from 7989 institutions across 131 countries collaborated to publish 6356 papers related to critical care for older adults in 1715 academic journals. The United States of America and China were the top contributors in terms of research studies, while Bertrand Guidet was the most prolific author with the highest number of articles. A dual-map overlay of the literature revealed that research papers published in Molecular/Biology/Genetics and Health/Nursing/Medicine journals were frequently referenced in Medicine/Medical/Clinical journals. Older patients with coronavirus disease 2019, delirium, and frailty were new trends and developing areas of interest. This is the first bibliometric study focusing on critical care in older adults. The research topics indicate that a comprehensive geriatric assessment, tailored interventions, and specific therapeutic algorithms among older adults are recommended to improve outcomes. Furthermore, this study provides valuable insights for clinical decision-making, guideline development, and resource allocation in critical care settings.
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Affiliation(s)
- Zhe Du
- Trauma Center, Peking University People’s Hospital, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration (Ministry of Education), Beijing, China
| | - Fang Li
- Trauma Center, Peking University People’s Hospital, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration (Ministry of Education), Beijing, China
| | - Tianbing Wang
- Trauma Center, Peking University People’s Hospital, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration (Ministry of Education), Beijing, China
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Rodríguez-Belenguer P, Piñana JL, Sánchez-Montañés M, Soria-Olivas E, Martínez-Sober M, Serrano-López AJ. A machine learning approach to identify groups of patients with hematological malignant disorders. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 246:108011. [PMID: 38325024 DOI: 10.1016/j.cmpb.2024.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 12/06/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Vaccination against SARS-CoV-2 in immunocompromised patients with hematologic malignancies (HM) is crucial to reduce the severity of COVID-19. Despite vaccination efforts, over a third of HM patients remain unresponsive, increasing their risk of severe breakthrough infections. This study aims to leverage machine learning's adaptability to COVID-19 dynamics, efficiently selecting patient-specific features to enhance predictions and improve healthcare strategies. Highlighting the complex COVID-hematology connection, the focus is on interpretable machine learning to provide valuable insights to clinicians and biologists. METHODS The study evaluated a dataset with 1166 patients with hematological diseases. The output was the achievement or non-achievement of a serological response after full COVID-19 vaccination. Various machine learning methods were applied, with the best model selected based on metrics such as the Area Under the Curve (AUC), Sensitivity, Specificity, and Matthew Correlation Coefficient (MCC). Individual SHAP values were obtained for the best model, and Principal Component Analysis (PCA) was applied to these values. The patient profiles were then analyzed within identified clusters. RESULTS Support vector machine (SVM) emerged as the best-performing model. PCA applied to SVM-derived SHAP values resulted in four perfectly separated clusters. These clusters are characterized by the proportion of patients that generate antibodies (PPGA). Cluster 1, with the second-highest PPGA (69.91%), included patients with aggressive diseases and factors contributing to increased immunodeficiency. Cluster 2 had the lowest PPGA (33.3%), but the small sample size limited conclusive findings. Cluster 3, representing the majority of the population, exhibited a high rate of antibody generation (84.39%) and a better prognosis compared to cluster 1. Cluster 4, with a PPGA of 66.33%, included patients with B-cell non-Hodgkin's lymphoma on corticosteroid therapy. CONCLUSIONS The methodology successfully identified four separate patient clusters using Machine Learning and Explainable AI (XAI). We then analyzed each cluster based on the percentage of HM patients who generated antibodies after COVID-19 vaccination. The study suggests the methodology's potential applicability to other diseases, highlighting the importance of interpretable ML in healthcare research and decision-making.
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Affiliation(s)
- Pablo Rodríguez-Belenguer
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
| | - José Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Manuel Sánchez-Montañés
- Department of Computer Science, Escuela Politécnica Superior, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
| | - Emilio Soria-Olivas
- IDAL, Intelligent Data Analysis Laboratory, ETSE, Universitat de València, 46100 Valencia, Spain
| | - Marcelino Martínez-Sober
- IDAL, Intelligent Data Analysis Laboratory, ETSE, Universitat de València, 46100 Valencia, Spain
| | - Antonio J Serrano-López
- IDAL, Intelligent Data Analysis Laboratory, ETSE, Universitat de València, 46100 Valencia, Spain
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Malaguti MC, Gios L, Giometto B, Longo C, Riello M, Ottaviani D, Pellegrini M, Di Giacopo R, Donner D, Rozzanigo U, Chierici M, Moroni M, Jurman G, Bincoletto G, Pardini M, Bacchin R, Nobili F, Di Biasio F, Avanzino L, Marchese R, Mandich P, Garbarino S, Pagano M, Campi C, Piana M, Marenco M, Uccelli A, Osmani V. Artificial intelligence of imaging and clinical neurological data for predictive, preventive and personalized (P3) medicine for Parkinson Disease: The NeuroArtP3 protocol for a multi-center research study. PLoS One 2024; 19:e0300127. [PMID: 38483951 PMCID: PMC10939244 DOI: 10.1371/journal.pone.0300127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The burden of Parkinson Disease (PD) represents a key public health issue and it is essential to develop innovative and cost-effective approaches to promote sustainable diagnostic and therapeutic interventions. In this perspective the adoption of a P3 (predictive, preventive and personalized) medicine approach seems to be pivotal. The NeuroArtP3 (NET-2018-12366666) is a four-year multi-site project co-funded by the Italian Ministry of Health, bringing together clinical and computational centers operating in the field of neurology, including PD. OBJECTIVE The core objectives of the project are: i) to harmonize the collection of data across the participating centers, ii) to structure standardized disease-specific datasets and iii) to advance knowledge on disease's trajectories through machine learning analysis. METHODS The 4-years study combines two consecutive research components: i) a multi-center retrospective observational phase; ii) a multi-center prospective observational phase. The retrospective phase aims at collecting data of the patients admitted at the participating clinical centers. Whereas the prospective phase aims at collecting the same variables of the retrospective study in newly diagnosed patients who will be enrolled at the same centers. RESULTS The participating clinical centers are the Provincial Health Services (APSS) of Trento (Italy) as the center responsible for the PD study and the IRCCS San Martino Hospital of Genoa (Italy) as the promoter center of the NeuroartP3 project. The computational centers responsible for data analysis are the Bruno Kessler Foundation of Trento (Italy) with TrentinoSalute4.0 -Competence Center for Digital Health of the Province of Trento (Italy) and the LISCOMPlab University of Genoa (Italy). CONCLUSIONS The work behind this observational study protocol shows how it is possible and viable to systematize data collection procedures in order to feed research and to advance the implementation of a P3 approach into the clinical practice through the use of AI models.
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Affiliation(s)
| | - Lorenzo Gios
- TrentinoSalute4.0 –Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Bruno Giometto
- Centro Interdipartimentale di Scienze Mediche (CISMed), Facoltà di Medicina e Chirurgia, Università di Trento, Trento, Italy
| | - Chiara Longo
- Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Marianna Riello
- Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | | | | | | | - Davide Donner
- Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Umberto Rozzanigo
- Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | | | - Monica Moroni
- Fondazione Bruno Kessler Research Center, Trento, Italy
| | | | | | - Matteo Pardini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ruggero Bacchin
- Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | | | - Paola Mandich
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- DINOGMI Department, University of Genoa, Genoa, Italy
| | | | - Mattia Pagano
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Campi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento Di Matematica, Università Di Genova, Genoa, Italy
| | - Michele Piana
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento Di Matematica, Università Di Genova, Genoa, Italy
| | | | | | - Venet Osmani
- Fondazione Bruno Kessler Research Center, Trento, Italy
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Moradi H, Bunnell HT, Price BS, Khodaverdi M, Vest MT, Porterfield JZ, Anzalone AJ, Santangelo SL, Kimble W, Harper J, Hillegass WB, Hodder SL. Assessing the effects of therapeutic combinations on SARS-CoV-2 infected patient outcomes: A big data approach. PLoS One 2023; 18:e0282587. [PMID: 36893086 PMCID: PMC9997963 DOI: 10.1371/journal.pone.0282587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has demonstrated the need for efficient and comprehensive, simultaneous assessment of multiple combined novel therapies for viral infection across the range of illness severity. Randomized Controlled Trials (RCT) are the gold standard by which efficacy of therapeutic agents is demonstrated. However, they rarely are designed to assess treatment combinations across all relevant subgroups. A big data approach to analyzing real-world impacts of therapies may confirm or supplement RCT evidence to further assess effectiveness of therapeutic options for rapidly evolving diseases such as COVID-19. METHODS Gradient Boosted Decision Tree, Deep and Convolutional Neural Network classifiers were implemented and trained on the National COVID Cohort Collaborative (N3C) data repository to predict the patients' outcome of death or discharge. Models leveraged the patients' characteristics, the severity of COVID-19 at diagnosis, and the calculated proportion of days on different treatment combinations after diagnosis as features to predict the outcome. Then, the most accurate model is utilized by eXplainable Artificial Intelligence (XAI) algorithms to provide insights about the learned treatment combination impacts on the model's final outcome prediction. RESULTS Gradient Boosted Decision Tree classifiers present the highest prediction accuracy in identifying patient outcomes with area under the receiver operator characteristic curve of 0.90 and accuracy of 0.81 for the outcomes of death or sufficient improvement to be discharged. The resulting model predicts the treatment combinations of anticoagulants and steroids are associated with the highest probability of improvement, followed by combined anticoagulants and targeted antivirals. In contrast, monotherapies of single drugs, including use of anticoagulants without steroid or antivirals are associated with poorer outcomes. CONCLUSIONS This machine learning model by accurately predicting the mortality provides insights about the treatment combinations associated with clinical improvement in COVID-19 patients. Analysis of the model's components suggests benefit to treatment with combination of steroids, antivirals, and anticoagulant medication. The approach also provides a framework for simultaneously evaluating multiple real-world therapeutic combinations in future research studies.
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Affiliation(s)
- Hamidreza Moradi
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | | | - Bradley S. Price
- West Virginia University, Morgantown, WV, United States of America
| | - Maryam Khodaverdi
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
| | - Michael T. Vest
- Christiana Care Health System, Newark, DE, United States of America
| | | | - Alfred J. Anzalone
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | | | - Wesley Kimble
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
| | - Jeremy Harper
- Owl Health Works LLC, Indianapolis, IN, United States of America
| | | | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
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Mavragani A, Hardy F, Tucker K, Hopper A, Marchã MJM, Navaratnam AV, Briggs TWR, Yates J, Day J, Wheeler A, Eve-Jones S, Gray WK. Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data. Interact J Med Res 2022; 11:e41520. [PMID: 36423306 PMCID: PMC9746678 DOI: 10.2196/41520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. OBJECTIVE We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. METHODS This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. RESULTS In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. CONCLUSIONS The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19.
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Affiliation(s)
| | - Flavien Hardy
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Katie Tucker
- Innovation and Intelligent Automation Unit, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Adrian Hopper
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Maria J M Marchã
- Science and Technology Facilities Council Distributed Research Utilising Advanced Computing High Performance Computing Facility, University College London, London, United Kingdom
| | - Annakan V Navaratnam
- University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Tim W R Briggs
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Royal National Orthopaedic Hospital National Health Service Trust, London, United Kingdom
| | - Jeremy Yates
- Department of Computer Science, University College London, London, United Kingdom
| | - Jamie Day
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Andrew Wheeler
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Sue Eve-Jones
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - William K Gray
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
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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. PLOS DIGITAL HEALTH 2022; 1:e0000136. [PMID: 36812571 PMCID: PMC9931233 DOI: 10.1371/journal.pdig.0000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
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.
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