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Tang CY, Gao C, Prasai K, Li T, Dash S, McElroy JA, Hang J, Wan XF. Prediction models for COVID-19 disease outcomes. Emerg Microbes Infect 2024; 13:2361791. [PMID: 38828796 PMCID: PMC11182058 DOI: 10.1080/22221751.2024.2361791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/26/2024] [Indexed: 06/05/2024]
Abstract
SARS-CoV-2 has caused over 6.9 million deaths and continues to produce lasting health consequences. COVID-19 manifests broadly from no symptoms to death. In a retrospective cross-sectional study, we developed personalized risk assessment models that predict clinical outcomes for individuals with COVID-19 and inform targeted interventions. We sequenced viruses from SARS-CoV-2-positive nasopharyngeal swab samples between July 2020 and July 2022 from 4450 individuals in Missouri and retrieved associated disease courses, clinical history, and urban-rural classification. We integrated this data to develop machine learning-based predictive models to predict hospitalization, ICU admission, and long COVID.The mean age was 38.3 years (standard deviation = 21.4) with 55.2% (N = 2453) females and 44.8% (N = 1994) males (not reported, N = 4). Our analyses revealed a comprehensive set of predictors for each outcome, encompassing human, environment, and virus genome-wide genetic markers. Immunosuppression, cardiovascular disease, older age, cardiac, gastrointestinal, and constitutional symptoms, rural residence, and specific amino acid substitutions were associated with hospitalization. ICU admission was associated with acute respiratory distress syndrome, ventilation, bacterial co-infection, rural residence, and non-wild type SARS-CoV-2 variants. Finally, long COVID was associated with hospital admission, ventilation, and female sex.Overall, we developed risk assessment models that offer the capability to identify patients with COVID-19 necessitating enhanced monitoring or early interventions. Of importance, we demonstrate the value of including key elements of virus, host, and environmental factors to predict patient outcomes, serving as a valuable platform in the field of personalized medicine with the potential for adaptation to other infectious diseases.
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Affiliation(s)
- Cynthia Y. Tang
- Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Cheng Gao
- Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Department of Electrical Engineering & Computer Science, College of Engineering, University of Missouri, Columbia, Missouri, USA
| | - Kritika Prasai
- Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Department of Electrical Engineering & Computer Science, College of Engineering, University of Missouri, Columbia, Missouri, USA
| | - Tao Li
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Shreya Dash
- Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Jane A. McElroy
- Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jun Hang
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Xiu-Feng Wan
- Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri, USA
- Department of Electrical Engineering & Computer Science, College of Engineering, University of Missouri, Columbia, Missouri, USA
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Özçevik Subaşi D, Akça Sümengen A, Semerci R, Şimşek E, Çakır GN, Temizsoy E. Paediatric nurses' perspectives on artificial intelligence applications: A cross-sectional study of concerns, literacy levels and attitudes. J Adv Nurs 2024. [PMID: 39003632 DOI: 10.1111/jan.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
AIMS This study aimed to explore the correlation between artificial intelligence (AI) literacy, AI anxiety and AI attitudes among paediatric nurses, as well as identify the influencing factors on paediatric nurses' AI attitudes. DESIGN A descriptive, correlational and cross-sectional research. METHODS This study was conducted between January and February 2024 with 170 nurses actively working in paediatric clinics in Turkey. The data collection tools included the Nurse Information Form, the General Attitudes Towards Artificial Intelligence Scale (GAAIS), the Artificial Intelligence Literacy Scale (AILS) and the Artificial Intelligence Anxiety Scale (AIAS). To determine the associations between the variables, the data was analysed using IBM SPSS 28, which included linear regression and Pearson correlation analysis. RESULTS The study indicated significant positive correlations between paediatric nurses' age and their AIAS scores (r = .226; p < .01) and significant negative correlations between paediatric nurses' age and their AILS (r = -.192; p < .05) and GAAIS scores (r = -.152; p < .05). The GAAIS was significantly predictive (p < .000) and accounted for 50% of the variation in AIAS and AILS scores. CONCLUSION Paediatric nurses' attitudes towards AI significantly predicted AI literacy and AI anxiety. The relationship between the age of the paediatric nurses and the anxiety, AI literacy and attitudes towards AI was demonstrated. Healthcare and educational institutions should create customized training programs and awareness-raising activities for older nurses, as there are noticeable variations in the attitudes of paediatric nurses towards AI based on their age. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE Providing in-service AI training can help healthcare organizations improve paediatric nurses' attitudes towards AI, increase their AI literacy and reduce their anxiety. This training has the potential to impact their attitudes positively and reduce their anxiety. REPORTING METHOD The study results were critically reported using STROBE criteria. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Aylin Akça Sümengen
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Remziye Semerci
- Department of Pediatric Nursing, School of Nursing, Koç University, Istanbul, Turkey
| | - Enes Şimşek
- Department of Pediatric Nursing, School of Nursing, Koç University, Istanbul, Turkey
| | - Gökçe Naz Çakır
- Department of Nursing, Faculty of Health Science, Yeditepe University, Istanbul, Turkey
| | - Ebru Temizsoy
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
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Parikh V, Tariq A, Patel B, Banerjee I. Comparative Analysis of Fusion Strategies for Imaging and Non-imaging Data - Use-case of Hospital Discharge Prediction. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:652-661. [PMID: 38827051 PMCID: PMC11141810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Accurate prediction of future clinical events such as discharge from hospital can not only improve hospital resource management but also provide an indicator of a patient's clinical condition. Within the scope of this work, we perform a comparative analysis of deep learning based fusion strategies against traditional single source models for prediction of discharge from hospital by fusing information encoded in two diverse but relevant data modalities, i.e., chest X-ray images and tabular electronic health records (EHR). We evaluate multiple fusion strategies including late, early and joint fusion in terms of their efficacy for target prediction compared to EHR-only and Image-only predictive models. Results indicated the importance of merging information from two modalities for prediction as fusion models tended to outperform single modality models and indicate that the joint fusion scheme was the most effective for target prediction. Joint fusion model merges the two modalities through a branched neural network that is jointly trained in an end-to-end fashion to extract target-relevant information from both modalities.
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Fernández D, Perez-Alvarez N, Molist G. COVID-19 patient profiles over four waves in Barcelona metropolitan area: A clustering approach. PLoS One 2024; 19:e0302461. [PMID: 38713649 DOI: 10.1371/journal.pone.0302461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/03/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVES Identifying profiles of hospitalized COVID-19 patients and explore their association with different degrees of severity of COVID-19 outcomes (i.e. in-hospital mortality, ICU assistance, and invasive mechanical ventilation). The findings of this study could inform the development of multiple care intervention strategies to improve patient outcomes. METHODS Prospective multicentre cohort study during four different waves of COVID-19 from March 1st, 2020 to August 31st, 2021 in four health consortiums within the southern Barcelona metropolitan region. From a starting point of over 292 demographic characteristics, comorbidities, vital signs, severity scores, and clinical analytics at hospital admission, we used both clinical judgment and supervised statistical methods to reduce to the 36 most informative completed covariates according to the disease outcomes for each wave. Patients were then grouped using an unsupervised semiparametric method (KAMILA). Results were interpreted by clinical and statistician team consensus to identify clinically-meaningful patient profiles. RESULTS The analysis included nw1 = 1657, nw2 = 697, nw3 = 677, and nw4 = 787 hospitalized-COVID-19 patients for each of the four waves. Clustering analysis identified 2 patient profiles for waves 1 and 3, while 3 profiles were determined for waves 2 and 4. Patients allocated in those groups showed a different percentage of disease outcomes (e.g., wave 1: 15.9% (Cluster 1) vs. 31.8% (Cluster 2) for in-hospital mortality rate). The main factors to determine groups were the patient's age and number of obese patients, number of comorbidities, oxygen support requirement, and various severity scores. The last wave is also influenced by the massive incorporation of COVID-19 vaccines. CONCLUSION Our study suggests that a single care model at hospital admission may not meet the needs of hospitalized-COVID-19 adults. A clustering approach appears to be appropriate for helping physicians to differentiate patients and, thus, apply multiple care intervention strategies, as another way of responding to new outbreaks of this or future diseases.
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Affiliation(s)
- Daniel Fernández
- Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
- Institute of Mathematics of UPC - BarcelonaTech (IMTech), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain
| | - Nuria Perez-Alvarez
- Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
- Estudis d'Informàtica, Multimèdia i Telecomunicació, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Gemma Molist
- Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Spain
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Bofa A, Zewotir T. Optimizing spatio-temporal correlation structures for modeling food security in Africa: a simulation-based investigation. BMC Bioinformatics 2024; 25:168. [PMID: 38678218 PMCID: PMC11056055 DOI: 10.1186/s12859-024-05791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
This study investigates the impact of spatio- temporal correlation using four spatio-temporal models: Spatio-Temporal Poisson Linear Trend Model (SPLTM), Poisson Temporal Model (TMS), Spatio-Temporal Poisson Anova Model (SPAM), and Spatio-Temporal Poisson Separable Model (STSM) concerning food security and nutrition in Africa. Evaluating model goodness of fit using the Watanabe Akaike Information Criterion (WAIC) and assessing bias through root mean square error and mean absolute error values revealed a consistent monotonic pattern. SPLTM consistently demonstrates a propensity for overestimating food security, while TMS exhibits a diverse bias profile, shifting between overestimation and underestimation based on varying correlation settings. SPAM emerges as a beacon of reliability, showcasing minimal bias and WAIC across diverse scenarios, while STSM consistently underestimates food security, particularly in regions marked by low to moderate spatio-temporal correlation. SPAM consistently outperforms other models, making it a top choice for modeling food security and nutrition dynamics in Africa. This research highlights the impact of spatial and temporal correlations on food security and nutrition patterns and provides guidance for model selection and refinement. Researchers are encouraged to meticulously evaluate the biases and goodness of fit characteristics of models, ensuring their alignment with the specific attributes of their data and research goals. This knowledge empowers researchers to select models that offer reliability and consistency, enhancing the applicability of their findings.
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Affiliation(s)
- Adusei Bofa
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu Natal, Oliver Tambo Building, Westville Campus, Durban, South Africa.
| | - Temesgen Zewotir
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu Natal, Oliver Tambo Building, Westville Campus, Durban, South Africa
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Ruksakulpiwat S, Thorngthip S, Niyomyart A, Benjasirisan C, Phianhasin L, Aldossary H, Ahmed BH, Samai T. A Systematic Review of the Application of Artificial Intelligence in Nursing Care: Where are We, and What's Next? J Multidiscip Healthc 2024; 17:1603-1616. [PMID: 38628616 PMCID: PMC11020344 DOI: 10.2147/jmdh.s459946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
Background Integrating Artificial Intelligence (AI) into healthcare has transformed the landscape of patient care and healthcare delivery. Despite this, there remains a notable gap in the existing literature synthesizing the comprehensive understanding of AI's utilization in nursing care. Objective This systematic review aims to synthesize the available evidence to comprehensively understand the application of AI in nursing care. Methods Studies published between January 2019 and December 2023, identified through CINAHL Plus with Full Text, Web of Science, PubMed, and Medline, were included in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the identification, screening, exclusion, and inclusion of articles. The convergent integrated analysis framework, as proposed by the Joanna Briggs Institute, was employed to synthesize data from the included studies for theme generation. Results A total of 337 records were identified from databases. Among them, 35 duplicates were removed, and 302 records underwent eligibility screening. After applying inclusion and exclusion criteria, eleven studies were deemed eligible and included in this review. Through data synthesis of these studies, six themes pertaining to the use of AI in nursing care were identified: 1) Risk Identification, 2) Health Assessment, 3) Patient Classification, 4) Research Development, 5) Improved Care Delivery and Medical Records, and 6) Developing a Nursing Care Plan. Conclusion This systematic review contributes valuable insights into the multifaceted applications of AI in nursing care. Through the synthesis of data from the included studies, six distinct themes emerged. These findings not only consolidate the current knowledge base but also underscore the diverse ways in which AI is shaping and improving nursing care practices.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sutthinee Thorngthip
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Atsadaporn Niyomyart
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Lalipat Phianhasin
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Heba Aldossary
- Department of Nursing, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Bootan Hasan Ahmed
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Thanistha Samai
- Department of Public Health Nursing, Faculty of Nursing, Mahidol University, Nakhon Pathom, Thailand
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Tariq MU, Ismail SB. Deep learning in public health: Comparative predictive models for COVID-19 case forecasting. PLoS One 2024; 19:e0294289. [PMID: 38483948 PMCID: PMC10939212 DOI: 10.1371/journal.pone.0294289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/28/2023] [Indexed: 03/17/2024] Open
Abstract
The COVID-19 pandemic has had a significant impact on both the United Arab Emirates (UAE) and Malaysia, emphasizing the importance of developing accurate and reliable forecasting mechanisms to guide public health responses and policies. In this study, we compared several cutting-edge deep learning models, including Long Short-Term Memory (LSTM), bidirectional LSTM, Convolutional Neural Networks (CNN), hybrid CNN-LSTM, Multilayer Perceptron's, and Recurrent Neural Networks (RNN), to project COVID-19 cases in the aforementioned regions. These models were calibrated and evaluated using a comprehensive dataset that includes confirmed case counts, demographic data, and relevant socioeconomic factors. To enhance the performance of these models, Bayesian optimization techniques were employed. Subsequently, the models were re-evaluated to compare their effectiveness. Analytic approaches, both predictive and retrospective in nature, were used to interpret the data. Our primary objective was to determine the most effective model for predicting COVID-19 cases in the United Arab Emirates (UAE) and Malaysia. The findings indicate that the selected deep learning algorithms were proficient in forecasting COVID-19 cases, although their efficacy varied across different models. After a thorough evaluation, the model architectures most suitable for the specific conditions in the UAE and Malaysia were identified. Our study contributes significantly to the ongoing efforts to combat the COVID-19 pandemic, providing crucial insights into the application of sophisticated deep learning algorithms for the precise and timely forecasting of COVID-19 cases. These insights hold substantial value for shaping public health strategies, enabling authorities to develop targeted and evidence-based interventions to manage the virus spread and its impact on the populations of the UAE and Malaysia. The study confirms the usefulness of deep learning methodologies in efficiently processing complex datasets and generating reliable projections, a skill of great importance in healthcare and professional settings.
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Affiliation(s)
- Muhammad Usman Tariq
- Abu Dhabi University, Abu Dhabi, United Arab Emirates
- Universiti Tun Hussein Onn Malaysia (UTHM), Parit Raja, Malaysia
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Gabaldi CQ, Cypriano AS, Pedrotti CHS, Malheiro DT, Laselva CR, Cendoroglo M, Teich VD. 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? EINSTEIN-SAO PAULO 2024; 22:eAO0328. [PMID: 38477720 PMCID: PMC10948090 DOI: 10.31744/einstein_journal/2024ao0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/14/2023] [Indexed: 03/14/2024] Open
Abstract
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.
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Affiliation(s)
- Caio Querino Gabaldi
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Adriana Serra Cypriano
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Daniel Tavares Malheiro
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Claudia Regina Laselva
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Miguel Cendoroglo
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Vanessa Damazio Teich
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Yin M, Xu C, Zhu J, Xue Y, Zhou Y, He Y, Lin J, Liu L, Gao J, Liu X, Shen D, Fu C. Automated machine learning for the identification of asymptomatic COVID-19 carriers based on chest CT images. BMC Med Imaging 2024; 24:50. [PMID: 38413923 PMCID: PMC10900643 DOI: 10.1186/s12880-024-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Asymptomatic COVID-19 carriers with normal chest computed tomography (CT) scans have perpetuated the ongoing pandemic of this disease. This retrospective study aimed to use automated machine learning (AutoML) to develop a prediction model based on CT characteristics for the identification of asymptomatic carriers. METHODS Asymptomatic carriers were from Yangzhou Third People's Hospital from August 1st, 2020, to March 31st, 2021, and the control group included a healthy population from a nonepizootic area with two negative RT‒PCR results within 48 h. All CT images were preprocessed using MATLAB. Model development and validation were conducted in R with the H2O package. The models were built based on six algorithms, e.g., random forest and deep neural network (DNN), and a training set (n = 691). The models were improved by automatically adjusting hyperparameters for an internal validation set (n = 306). The performance of the obtained models was evaluated based on a dataset from Suzhou (n = 178) using the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and F1 score. RESULTS A total of 1,175 images were preprocessed with high stability. Six models were developed, and the performance of the DNN model ranked first, with an AUC value of 0.898 for the test set. The sensitivity, specificity, PPV, NPV, F1 score and accuracy of the DNN model were 0.820, 0.854, 0.849, 0.826, 0.834 and 0.837, respectively. A plot of a local interpretable model-agnostic explanation demonstrated how different variables worked in identifying asymptomatic carriers. CONCLUSIONS Our study demonstrates that AutoML models based on CT images can be used to identify asymptomatic carriers. The most promising model for clinical implementation is the DNN-algorithm-based model.
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Affiliation(s)
- Minyue Yin
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
- Suzhou Clinical Center of Digestive Diseases, 215006, Suzhou, Jiangsu, China
| | - Chao Xu
- Department of Radiotherapy, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
- The 23th ward, Yangzhou Third People's Hospital, 225000, Yangzhou, Jiangsu, China
- Suzhou Clinical Center of Digestive Diseases, 215006, Suzhou, Jiangsu, China
| | - Yuhan Xue
- Medical School, Soochow University, 215006, Suzhou, Jiangsu, China
| | - Yijia Zhou
- Medical School, Soochow University, 215006, Suzhou, Jiangsu, China
| | - Yu He
- Medical School, Soochow University, 215006, Suzhou, Jiangsu, China
| | - Jiaxi Lin
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
- Suzhou Clinical Center of Digestive Diseases, 215006, Suzhou, Jiangsu, China
| | - Lu Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
- Suzhou Clinical Center of Digestive Diseases, 215006, Suzhou, Jiangsu, China
| | - Jingwen Gao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
- Suzhou Clinical Center of Digestive Diseases, 215006, Suzhou, Jiangsu, China
| | - Xiaolin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China
- Suzhou Clinical Center of Digestive Diseases, 215006, Suzhou, Jiangsu, China
| | - Dan Shen
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China.
| | - Cuiping Fu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, 215006, Suzhou, Jiangsu, China.
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Rahmatinejad Z, Dehghani T, Hoseini B, Rahmatinejad F, Lotfata A, Reihani H, Eslami S. A comparative study of explainable ensemble learning and logistic regression for predicting in-hospital mortality in the emergency department. Sci Rep 2024; 14:3406. [PMID: 38337000 PMCID: PMC10858239 DOI: 10.1038/s41598-024-54038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
This study addresses the challenges associated with emergency department (ED) overcrowding and emphasizes the need for efficient risk stratification tools to identify high-risk patients for early intervention. While several scoring systems, often based on logistic regression (LR) models, have been proposed to indicate patient illness severity, this study aims to compare the predictive performance of ensemble learning (EL) models with LR for in-hospital mortality in the ED. A cross-sectional single-center study was conducted at the ED of Imam Reza Hospital in northeast Iran from March 2016 to March 2017. The study included adult patients with one to three levels of emergency severity index. EL models using Bagging, AdaBoost, random forests (RF), Stacking and extreme gradient boosting (XGB) algorithms, along with an LR model, were constructed. The training and validation visits from the ED were randomly divided into 80% and 20%, respectively. After training the proposed models using tenfold cross-validation, their predictive performance was evaluated. Model performance was compared using the Brier score (BS), The area under the receiver operating characteristics curve (AUROC), The area and precision-recall curve (AUCPR), Hosmer-Lemeshow (H-L) goodness-of-fit test, precision, sensitivity, accuracy, F1-score, and Matthews correlation coefficient (MCC). The study included 2025 unique patients admitted to the hospital's ED, with a total percentage of hospital deaths at approximately 19%. In the training group and the validation group, 274 of 1476 (18.6%) and 152 of 728 (20.8%) patients died during hospitalization, respectively. According to the evaluation of the presented framework, EL models, particularly Bagging, predicted in-hospital mortality with the highest AUROC (0.839, CI (0.802-0.875)) and AUCPR = 0.64 comparable in terms of discrimination power with LR (AUROC (0.826, CI (0.787-0.864)) and AUCPR = 0.61). XGB achieved the highest precision (0.83), sensitivity (0.831), accuracy (0.842), F1-score (0.833), and the highest MCC (0.48). Additionally, the most accurate models in the unbalanced dataset belonged to RF with the lowest BS (0.128). Although all studied models overestimate mortality risk and have insufficient calibration (P > 0.05), stacking demonstrated relatively good agreement between predicted and actual mortality. EL models are not superior to LR in predicting in-hospital mortality in the ED. Both EL and LR models can be considered as screening tools to identify patients at risk of mortality.
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Affiliation(s)
- Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Toktam Dehghani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Toos Institute of Higher Education, Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aynaz Lotfata
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
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11
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Bathe J, Renner HJ, Watzinger S, Olave-Rojas D, Hannappel L, Wnent J, Nickel S, Gräsner JT. [The SCATTER project: computer-based simulation in the strategic transfer of intensive care patients]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:215-224. [PMID: 38153419 PMCID: PMC10834643 DOI: 10.1007/s00103-023-03811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The need for a concept for the nationwide strategic transfer of critical care patients in Germany was highlighted during the COVID-19 (coronavirus disease 2019) pandemic. Despite the cloverleaf concept developed specifically for this purpose, the transfer of large numbers of critical care patients represents a major challenge. With the help of a computer simulation, the SCATTER research project uses a fictitious example to test, develop, and recommend transfer strategies. METHOD The simulation was programmed after collecting procedural and structural data on critical care transports within Germany. The simulation allows altering various parameters and testing different transfer scenarios. In a fictitious scenario, nationwide transfers starting from Schleswig-Holstein were simulated and evaluated using predetermined criteria. RESULTS In the case of ground-based transfers, it became apparent that, depending on the selected target region, not all patients could be transferred due to the limited range of ground-based vehicles. Although a higher number of patients can be transferred by air, this is associated with additional gurney changes and potential risk to the patient. A distance-dependent transport strategy led to the identical results as purely air-bound transport, since air-bound transport was always chosen due to the long distances. DISCUSSION The simulation can be used to develop recommendations and to draw important conclusions from different transfer strategies.
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Affiliation(s)
- Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Campus Kiel und Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 808, 24105, Kiel, Deutschland.
| | - Hanna-Joy Renner
- Institut für Rettungs- und Notfallmedizin, Campus Kiel und Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 808, 24105, Kiel, Deutschland
| | - Sven Watzinger
- Institut für Operations Research - Diskrete Optimierung und Logistik, Karlsruher Institut für Technologie, Karlsruhe, Deutschland
| | - David Olave-Rojas
- Institut für Operations Research - Diskrete Optimierung und Logistik, Karlsruher Institut für Technologie, Karlsruhe, Deutschland
| | - Leonie Hannappel
- Institut für Rettungs- und Notfallmedizin, Campus Kiel und Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 808, 24105, Kiel, Deutschland
- Fachgruppe Intensivmedizin, Infektiologie und Notfallmedizin (Fachgruppe COVRIIN), Fachgebiet ZBS 7 - Strategie und Einsatz, Koordination: Robert Koch-Institut, Berlin, Deutschland
| | - Jan Wnent
- Institut für Rettungs- und Notfallmedizin, Campus Kiel und Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 808, 24105, Kiel, Deutschland
- Fachgruppe Intensivmedizin, Infektiologie und Notfallmedizin (Fachgruppe COVRIIN), Fachgebiet ZBS 7 - Strategie und Einsatz, Koordination: Robert Koch-Institut, Berlin, Deutschland
- School of Medicine, University of Namibia, Windhoek, Namibia
- Klinik f. Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Stefan Nickel
- Institut für Operations Research - Diskrete Optimierung und Logistik, Karlsruher Institut für Technologie, Karlsruhe, Deutschland
| | - Jan-Thorsten Gräsner
- Institut für Rettungs- und Notfallmedizin, Campus Kiel und Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 808, 24105, Kiel, Deutschland
- Fachgruppe Intensivmedizin, Infektiologie und Notfallmedizin (Fachgruppe COVRIIN), Fachgebiet ZBS 7 - Strategie und Einsatz, Koordination: Robert Koch-Institut, Berlin, Deutschland
- Klinik f. Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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12
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Sun Y, Salerno S, Pan Z, Yang E, Sujimongkol C, Song J, Wang X, Han P, Zeng D, Kang J, Christiani DC, Li Y. Assessing the prognostic utility of clinical and radiomic features for COVID-19 patients admitted to ICU: challenges and lessons learned. HARVARD DATA SCIENCE REVIEW 2024; 6:10.1162/99608f92.9d86a749. [PMID: 38974963 PMCID: PMC11225107 DOI: 10.1162/99608f92.9d86a749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Severe cases of COVID-19 often necessitate escalation to the Intensive Care Unit (ICU), where patients may face grave outcomes, including mortality. Chest X-rays play a crucial role in the diagnostic process for evaluating COVID-19 patients. Our collaborative efforts with Michigan Medicine in monitoring patient outcomes within the ICU have motivated us to investigate the potential advantages of incorporating clinical information and chest X-ray images for predicting patient outcomes. We propose an analytical workflow to address challenges such as the absence of standardized approaches for image pre-processing and data utilization. We then propose an ensemble learning approach designed to maximize the information derived from multiple prediction algorithms. This entails optimizing the weights within the ensemble and considering the common variability present in individual risk scores. Our simulations demonstrate the superior performance of this weighted ensemble averaging approach across various scenarios. We apply this refined ensemble methodology to analyze post-ICU COVID-19 mortality, an occurrence observed in 21% of COVID-19 patients admitted to the ICU at Michigan Medicine. Our findings reveal substantial performance improvement when incorporating imaging data compared to models trained solely on clinical risk factors. Furthermore, the addition of radiomic features yields even larger enhancements, particularly among older and more medically compromised patients. These results may carry implications for enhancing patient outcomes in similar clinical contexts.
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Affiliation(s)
- Yuming Sun
- Biostatistics, University of Michigan, Ann Arbor, MI
| | | | - Ziyang Pan
- Biostatistics, University of Michigan, Ann Arbor, MI
| | - Eileen Yang
- Biostatistics, University of Michigan, Ann Arbor, MI
| | | | - Jiyeon Song
- Biostatistics, University of Michigan, Ann Arbor, MI
| | - Xinan Wang
- Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Peisong Han
- Biostatistics, University of Michigan, Ann Arbor, MI
| | - Donglin Zeng
- Biostatistics, University of Michigan, Ann Arbor, MI
| | - Jian Kang
- Biostatistics, University of Michigan, Ann Arbor, MI
| | - David C. Christiani
- Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yi Li
- Biostatistics, University of Michigan, Ann Arbor, MI
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Statlender L, Shvartser L, Teppler S, Bendavid I, Kushinir S, Azullay R, Singer P. Predicting invasive mechanical ventilation in COVID 19 patients: A validation study. PLoS One 2024; 19:e0296386. [PMID: 38166095 PMCID: PMC10760863 DOI: 10.1371/journal.pone.0296386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The decision to intubate and ventilate a patient is mainly clinical. Both delaying intubation (when needed) and unnecessarily invasively ventilating (when it can be avoided) are harmful. We recently developed an algorithm predicting respiratory failure and invasive mechanical ventilation in COVID-19 patients. This is an internal validation study of this model, which also suggests a categorized "time-weighted" model. METHODS We used a dataset of COVID-19 patients who were admitted to Rabin Medical Center after the algorithm was developed. We evaluated model performance in predicting ventilation, regarding the actual endpoint of each patient. We further categorized each patient into one of four categories, based on the strength of the prediction of ventilation over time. We evaluated this categorized model performance regarding the actual endpoint of each patient. RESULTS 881 patients were included in the study; 96 of them were ventilated. AUC of the original algorithm is 0.87-0.94. The AUC of the categorized model is 0.95. CONCLUSIONS A minor degradation in the algorithm accuracy was noted in the internal validation, however, its accuracy remained high. The categorized model allows accurate prediction over time, with very high negative predictive value.
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Affiliation(s)
- Liran Statlender
- Department of Gefneral Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | | | - Itai Bendavid
- Department of Gefneral Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Shiri Kushinir
- Rabin Medical Center Research Authority, Beilinson Hospital, Petah Tikva, Israel
| | - Roy Azullay
- TSG IT Advanced Systems Ltd., Or Yehuda, Israel
| | - Pierre Singer
- Department of Gefneral Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Barreto TDO, Veras NVR, Cardoso PH, Fernandes FRDS, Medeiros LPDS, Bezerra MV, de Andrade FMQ, Pinheiro CDO, Sánchez-Gendriz I, Silva GJPC, Rodrigues LF, de Morais AHF, dos Santos JPQ, Paiva JC, de Andrade IGM, Valentim RADM. Artificial intelligence applied to analyzes during the pandemic: COVID-19 beds occupancy in the state of Rio Grande do Norte, Brazil. Front Artif Intell 2023; 6:1290022. [PMID: 38145230 PMCID: PMC10748397 DOI: 10.3389/frai.2023.1290022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
The COVID-19 pandemic is already considered one of the biggest global health crises. In Rio Grande do Norte, a Brazilian state, the RegulaRN platform was the health information system used to regulate beds for patients with COVID-19. This article explored machine learning and deep learning techniques with RegulaRN data in order to identify the best models and parameters to predict the outcome of a hospitalized patient. A total of 25,366 bed regulations for COVID-19 patients were analyzed. The data analyzed comes from the RegulaRN Platform database from April 2020 to August 2022. From these data, the nine most pertinent characteristics were selected from the twenty available, and blank or inconclusive data were excluded. This was followed by the following steps: data pre-processing, database balancing, training, and test. The results showed better performance in terms of accuracy (84.01%), precision (79.57%), and F1-score (81.00%) for the Multilayer Perceptron model with Stochastic Gradient Descent optimizer. The best results for recall (84.67%), specificity (84.67%), and ROC-AUC (91.6%) were achieved by Root Mean Squared Propagation. This study compared different computational methods of machine and deep learning whose objective was to classify bed regulation data for patients with COVID-19 from the RegulaRN Platform. The results have made it possible to identify the best model to help health professionals during the process of regulating beds for patients with COVID-19. The scientific findings of this article demonstrate that the computational methods used applied through a digital health solution, can assist in the decision-making of medical regulators and government institutions in situations of public health crisis.
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Affiliation(s)
- Tiago de Oliveira Barreto
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Nícolas Vinícius Rodrigues Veras
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte (IFRN), Natal, Rio Grande do Norte, Brazil
| | - Pablo Holanda Cardoso
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte (IFRN), Natal, Rio Grande do Norte, Brazil
| | - Felipe Ricardo dos Santos Fernandes
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | | | - Maria Valéria Bezerra
- Secretary of Public Health of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | | | - Ignacio Sánchez-Gendriz
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Gleyson José Pinheiro Caldeira Silva
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte (IFRN), Natal, Rio Grande do Norte, Brazil
| | - Leandro Farias Rodrigues
- Brazilian Company of Hospital Services (EBSERH), University Hospital of Pelotas, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Antonio Higor Freire de Morais
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte (IFRN), Natal, Rio Grande do Norte, Brazil
| | - João Paulo Queiroz dos Santos
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte (IFRN), Natal, Rio Grande do Norte, Brazil
| | - Jailton Carlos Paiva
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte (IFRN), Natal, Rio Grande do Norte, Brazil
| | - Ion Garcia Mascarenhas de Andrade
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
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Fabrizzio GC, Erdmann AL, Oliveira LMD. Web App for prediction of hospitalisation in Intensive Care Unit by covid-19. Rev Bras Enferm 2023; 76:e20220740. [PMID: 38055477 DOI: 10.1590/0034-7167-2022-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To develop a Web App from a predictive model to estimate the risk of Intensive Care Unit (ICU) admission for patients with covid-19. METHODS An applied technological production research was carried out with the development of Streamlit using Python, considering the decision tree model that presented the best performance (AUC 0.668). RESULTS Based on the variables associated with Precision Nursing, Streamlit stratifies patients admitted to clinical units who are most likely to be admitted to the Intensive Care Unit, serving as a decision-making support tool for healthcare professionals. FINAL CONSIDERATIONS The performance of the model may have been influenced by the start of vaccination during the data collection period, however, the Web App via Streamlit proved to be a feasible tool for presenting research results, due to the ease of understanding by nurses and its potential for supporting clinical decision-making.
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Werner E, Clark JN, Hepburn A, Bhamber RS, Ambler M, Bourdeaux CP, McWilliams CJ, Santos-Rodriguez R. Explainable hierarchical clustering for patient subtyping and risk prediction. Exp Biol Med (Maywood) 2023; 248:2547-2559. [PMID: 38102763 PMCID: PMC10854470 DOI: 10.1177/15353702231214253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023] Open
Abstract
We present a pipeline in which machine learning techniques are used to automatically identify and evaluate subtypes of hospital patients admitted between 2017 and 2021 in a large UK teaching hospital. Patient clusters are determined using routinely collected hospital data, such as those used in the UK's National Early Warning Score 2 (NEWS2). An iterative, hierarchical clustering process was used to identify the minimum set of relevant features for cluster separation. With the use of state-of-the-art explainability techniques, the identified subtypes are interpreted and assigned clinical meaning, illustrating their robustness. In parallel, clinicians assessed intracluster similarities and intercluster differences of the identified patient subtypes within the context of their clinical knowledge. For each cluster, outcome prediction models were trained and their forecasting ability was illustrated against the NEWS2 of the unclustered patient cohort. These preliminary results suggest that subtype models can outperform the established NEWS2 method, providing improved prediction of patient deterioration. By considering both the computational outputs and clinician-based explanations in patient subtyping, we aim to highlight the mutual benefit of combining machine learning techniques with clinical expertise.
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Koraishy FM, Mallipattu SK. Dialysis resource allocation in critical care: the impact of the COVID-19 pandemic and the promise of big data analytics. FRONTIERS IN NEPHROLOGY 2023; 3:1266967. [PMID: 37965069 PMCID: PMC10641281 DOI: 10.3389/fneph.2023.1266967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
The COVID-19 pandemic resulted in an unprecedented burden on intensive care units (ICUs). With increased demands and limited supply, critical care resources, including dialysis machines, became scarce, leading to the undertaking of value-based cost-effectiveness analyses and the rationing of resources to deliver patient care of the highest quality. A high proportion of COVID-19 patients admitted to the ICU required dialysis, resulting in a major burden on resources such as dialysis machines, nursing staff, technicians, and consumables such as dialysis filters and solutions and anticoagulation medications. Artificial intelligence (AI)-based big data analytics are now being utilized in multiple data-driven healthcare services, including the optimization of healthcare system utilization. Numerous factors can impact dialysis resource allocation to critically ill patients, especially during public health emergencies, but currently, resource allocation is determined using a small number of traditional factors. Smart analytics that take into account all the relevant healthcare information in the hospital system and patient outcomes can lead to improved resource allocation, cost-effectiveness, and quality of care. In this review, we discuss dialysis resource utilization in critical care, the impact of the COVID-19 pandemic, and how AI can improve resource utilization in future public health emergencies. Research in this area should be an important priority.
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Affiliation(s)
- Farrukh M. Koraishy
- Division of Nephrology, Department of Medicine, Stony Brook University Hospital, , Stony Brook, NY, United States
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Chen R, Chen J, Yang S, Luo S, Xiao Z, Lu L, Liang B, Liu S, Shi H, Xu J. Prediction of prognosis in COVID-19 patients using machine learning: A systematic review and meta-analysis. Int J Med Inform 2023; 177:105151. [PMID: 37473658 DOI: 10.1016/j.ijmedinf.2023.105151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Accurate prediction of prognostic outcomes in patients with COVID-19 could facilitate clinical decision-making and medical resource allocation. However, little is known about the ability of machine learning (ML) to predict prognosis in COVID-19 patients. OBJECTIVE This study aimed to systematically examine the prognostic value of ML in patients with COVID-19. METHODS A systematic search was conducted in PubMed, Web of Science, Embase, Cochrane Library, and IEEE Xplore up to December 15, 2021. Studies predicting the prognostic outcomes of COVID-19 patients using ML were eligible for inclusion. Risk of bias was evaluated by a tailored checklist based on Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pooled sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated to evaluate model performance. RESULTS A total of 33 studies that described 35 models were eligible for inclusion, with 27 models presenting mortality, four intensive care unit (ICU) admission, and four use of ventilation. For predicting mortality, ML gave a pooled sensitivity of 0.86 (95% CI, 0.79-0.90), a specificity of 0.87 (95% CI, 0.80-0.92), and an AUC of 0.93 (95% CI, 0.90-0.95). For the prediction of ICU admission, ML had a sensitivity of 0.86 (95% CI, 0.78-0.92), a specificity of 0.81 (95% CI, 0.66-0.91), and an AUC of 0.91 (95% CI, 0.88-0.93). For the prediction of ventilation, ML had a sensitivity of 0.81 (95% CI, 0.68-0.90), a specificity of 0.78 (95% CI, 0.66-0.87), and an AUC of 0.87 (95% CI, 0.83-0.89). Meta-regression analyses indicated that algorithm, population, study design, and source of dataset influenced the pooled estimate. CONCLUSION This meta-analysis demonstrated the satisfactory performance of ML in predicting prognostic outcomes in patients with COVID-19, suggesting the potential value of ML to support clinical decision-making. However, improvements to methodology and validation are still necessary before its application in routine clinical practice.
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Affiliation(s)
- Ruiyao Chen
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Jiayuan Chen
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Sen Yang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Shuqing Luo
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Zhongzhou Xiao
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Lu Lu
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Bilin Liang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | | | - Huwei Shi
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Jie Xu
- Shanghai Artificial Intelligence Laboratory, Shanghai, China.
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Li H, Drukker K, Hu Q, Whitney HM, Fuhrman JD, Giger ML. Predicting intensive care need for COVID-19 patients using deep learning on chest radiography. J Med Imaging (Bellingham) 2023; 10:044504. [PMID: 37608852 PMCID: PMC10440543 DOI: 10.1117/1.jmi.10.4.044504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
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.
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Affiliation(s)
- Hui Li
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Karen Drukker
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Qiyuan Hu
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Heather M. Whitney
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Jordan D. Fuhrman
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Maryellen L. Giger
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
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Rahmatinejad Z, Hoseini B, Reihani H, Hanna AA, Pourmand A, Tabatabaei SM, Rahmatinejad F, Eslami S. Comparison of Six Scoring Systems for Predicting In-hospital Mortality among Patients with SARS-COV2 Presenting to the Emergency Department. Indian J Crit Care Med 2023; 27:416-425. [PMID: 37378368 PMCID: PMC10291668 DOI: 10.5005/jp-journals-10071-24463] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 06/29/2023] Open
Abstract
Background The study aimed to compare the prognostic accuracy of six different severity-of-illness scoring systems for predicting in-hospital mortality among patients with confirmed SARS-COV2 who presented to the emergency department (ED). The scoring systems assessed were worthing physiological score (WPS), early warning score (EWS), rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), national early warning score (NEWS), and quick sequential organ failure assessment (qSOFA). Materials and methods A cohort study was conducted using data obtained from electronic medical records of 6,429 confirmed SARS-COV2 patients presenting to the ED. Logistic regression models were fitted on the original severity-of-illness scores to assess the models' performance using the Area Under the Curve for ROC (AUC-ROC) and Precision-Recall curves (AUC-PR), Brier Score (BS), and calibration plots were used to assess the models' performance. Bootstrap samples with multiple imputations were used for internal validation. Results The mean age of the patients was 64 years (IQR:50-76) and 57.5% were male. The WPS, REMS, and NEWS models had AUROC of 0.714, 0.705, and 0.701, respectively. The poorest performance was observed in the RAPS model, with an AUROC of 0.601. The BS for the NEWS, qSOFA, EWS, WPS, RAPS, and REMS was 0.18, 0.09, 0.03, 0.14, 0.15, and 0.11 respectively. Excellent calibration was obtained for the NEWS, while the other models had proper calibration. Conclusion The WPS, REMS, and NEWS have a fair discriminatory performance and may assist in risk stratification for SARS-COV2 patients presenting to the ED. Generally, underlying diseases and most vital signs are positively associated with mortality and were different between the survivors and non-survivors. How to cite this article Rahmatinejad Z, Hoseini B, Reihani H, Hanna AA, Pourmand A, Tabatabaei SM, et al. Comparison of Six Scoring Systems for Predicting In-hospital Mortality among Patients with SARS-COV2 Presenting to the Emergency Department. Indian J Crit Care Med 2023;27(6):416-425.
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Affiliation(s)
- Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameen Abu Hanna
- Department of Medical Informatics, Amsterdam UMC – Location AMC, University of Amsterdam, the Netherlands
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University, School of Medicine and Health Sciences, Washington DC, United States
| | - Seyyed Mohammad Tabatabaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Health Information Technology, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Informatics, Amsterdam UMC – Location AMC, University of Amsterdam, the Netherlands
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Dabbagh R, Jamal A, Bhuiyan Masud JH, Titi MA, Amer YS, Khayat A, Alhazmi TS, Hneiny L, Baothman FA, Alkubeyyer M, Khan SA, Temsah MH. Harnessing Machine Learning in Early COVID-19 Detection and Prognosis: A Comprehensive Systematic Review. Cureus 2023; 15:e38373. [PMID: 37265897 PMCID: PMC10230599 DOI: 10.7759/cureus.38373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
During the early phase of the COVID-19 pandemic, reverse transcriptase-polymerase chain reaction (RT-PCR) testing faced limitations, prompting the exploration of machine learning (ML) alternatives for diagnosis and prognosis. Providing a comprehensive appraisal of such decision support systems and their use in COVID-19 management can aid the medical community in making informed decisions during the risk assessment of their patients, especially in low-resource settings. Therefore, the objective of this study was to systematically review the studies that predicted the diagnosis of COVID-19 or the severity of the disease using ML. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), we conducted a literature search of MEDLINE (OVID), Scopus, EMBASE, and IEEE Xplore from January 1 to June 31, 2020. The outcomes were COVID-19 diagnosis or prognostic measures such as death, need for mechanical ventilation, admission, and acute respiratory distress syndrome. We included peer-reviewed observational studies, clinical trials, research letters, case series, and reports. We extracted data about the study's country, setting, sample size, data source, dataset, diagnostic or prognostic outcomes, prediction measures, type of ML model, and measures of diagnostic accuracy. Bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with the number CRD42020197109. The final records included for data extraction were 66. Forty-three (64%) studies used secondary data. The majority of studies were from Chinese authors (30%). Most of the literature (79%) relied on chest imaging for prediction, while the remainder used various laboratory indicators, including hematological, biochemical, and immunological markers. Thirteen studies explored predicting COVID-19 severity, while the rest predicted diagnosis. Seventy percent of the articles used deep learning models, while 30% used traditional ML algorithms. Most studies reported high sensitivity, specificity, and accuracy for the ML models (exceeding 90%). The overall concern about the risk of bias was "unclear" in 56% of the studies. This was mainly due to concerns about selection bias. ML may help identify COVID-19 patients in the early phase of the pandemic, particularly in the context of chest imaging. Although these studies reflect that these ML models exhibit high accuracy, the novelty of these models and the biases in dataset selection make using them as a replacement for the clinicians' cognitive decision-making questionable. Continued research is needed to enhance the robustness and reliability of ML systems in COVID-19 diagnosis and prognosis.
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Affiliation(s)
- Rufaidah Dabbagh
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Amr Jamal
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | | | - Maher A Titi
- Quality Management Department, King Saud University Medical City, Riyadh, SAU
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Yasser S Amer
- Pediatrics, Quality Management Department, King Saud University Medical City, Riyadh, SAU
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Afnan Khayat
- Health Information Management Department, Prince Sultan Military College of Health Sciences, Al Dhahran, SAU
| | - Taha S Alhazmi
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Layal Hneiny
- Medicine, Wegner Health Sciences Library, University of South Dakota, Vermillion, USA
| | - Fatmah A Baothman
- Department of Information Systems, King Abdulaziz University, Jeddah, SAU
| | | | - Samina A Khan
- School of Computer Sciences, Universiti Sains Malaysia, Penang, MYS
| | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University, Riyadh, SAU
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Tariq A, Tang S, Sakhi H, Celi LA, Newsome JM, Rubin DL, Trivedi H, Gichoya JW, Banerjee I. Fusion of imaging and non-imaging data for disease trajectory prediction for coronavirus disease 2019 patients. J Med Imaging (Bellingham) 2023; 10:034004. [PMID: 37388280 PMCID: PMC10306115 DOI: 10.1117/1.jmi.10.3.034004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose Our study investigates whether graph-based fusion of imaging data with non-imaging electronic health records (EHR) data can improve the prediction of the disease trajectories for patients with coronavirus disease 2019 (COVID-19) beyond the prediction performance of only imaging or non-imaging EHR data. Approach We present a fusion framework for fine-grained clinical outcome prediction [discharge, intensive care unit (ICU) admission, or death] that fuses imaging and non-imaging information using a similarity-based graph structure. Node features are represented by image embedding, and edges are encoded with clinical or demographic similarity. Results Experiments on data collected from the Emory Healthcare Network indicate that our fusion modeling scheme performs consistently better than predictive models developed using only imaging or non-imaging features, with area under the receiver operating characteristics curve of 0.76, 0.90, and 0.75 for discharge from hospital, mortality, and ICU admission, respectively. External validation was performed on data collected from the Mayo Clinic. Our scheme highlights known biases in the model prediction, such as bias against patients with alcohol abuse history and bias based on insurance status. Conclusions Our study signifies the importance of the fusion of multiple data modalities for the accurate prediction of clinical trajectories. The proposed graph structure can model relationships between patients based on non-imaging EHR data, and graph convolutional networks can fuse this relationship information with imaging data to effectively predict future disease trajectory more effectively than models employing only imaging or non-imaging data. Our graph-based fusion modeling frameworks can be easily extended to other prediction tasks to efficiently combine imaging data with non-imaging clinical data.
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Affiliation(s)
- Amara Tariq
- Mayo Clinic, Department of Administration, Phoenix, Arizona, United States
| | - Siyi Tang
- Stanford University, Department of Electrical Engineering, Stanford, California, United States
| | - Hifza Sakhi
- Philadelphia College of Osteopathic Medicine - Georgia Campus, Swanee, Georgia, United States
| | - Leo Anthony Celi
- Massachusetts Institute of Technology, Boston, Massachusetts, United States
| | - Janice M. Newsome
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia, United States
| | - Daniel L. Rubin
- Stanford University, Department of Biomedical Data Science, Stanford, California, United States
- Stanford University, Department of Radiology, Stanford, California, United States
| | - Hari Trivedi
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia, United States
| | - Judy Wawira Gichoya
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia, United States
| | - Imon Banerjee
- Mayo Clinic, Department of Radiology, Phoenix, Arizona, United States
- Arizona State University, Ira A. Fulton School of Engineering, Department of Computer Engineering, Tempe, Arizona, United States
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Ortiz-Barrios M, Arias-Fonseca S, Ishizaka A, Barbati M, Avendaño-Collante B, Navarro-Jiménez E. Artificial intelligence and discrete-event simulation for capacity management of intensive care units during the Covid-19 pandemic: A case study. JOURNAL OF BUSINESS RESEARCH 2023; 160:113806. [PMID: 36895308 PMCID: PMC9981538 DOI: 10.1016/j.jbusres.2023.113806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Miguel Ortiz-Barrios
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 080002, Colombia
| | - Sebastián Arias-Fonseca
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 080002, Colombia
| | - Alessio Ishizaka
- NEOMA Business School, 1 rue du Maréchal Juin, Mont-Saint-Aignan 76130, France
| | - Maria Barbati
- Department of Economics, University Ca' Foscari, Cannaregio 873, Fondamenta San Giobbe, 30121 Venice, Italy
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24
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Sarmiento Varón L, González-Puelma J, Medina-Ortiz D, Aldridge J, Alvarez-Saravia D, Uribe-Paredes R, Navarrete MA. The role of machine learning in health policies during the COVID-19 pandemic and in long COVID management. Front Public Health 2023; 11:1140353. [PMID: 37113165 PMCID: PMC10126380 DOI: 10.3389/fpubh.2023.1140353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
The ongoing COVID-19 pandemic is arguably one of the most challenging health crises in modern times. The development of effective strategies to control the spread of SARS-CoV-2 were major goals for governments and policy makers. Mathematical modeling and machine learning emerged as potent tools to guide and optimize the different control measures. This review briefly summarizes the SARS-CoV-2 pandemic evolution during the first 3 years. It details the main public health challenges focusing on the contribution of mathematical modeling to design and guide government action plans and spread mitigation interventions of SARS-CoV-2. Next describes the application of machine learning methods in a series of study cases, including COVID-19 clinical diagnosis, the analysis of epidemiological variables, and drug discovery by protein engineering techniques. Lastly, it explores the use of machine learning tools for investigating long COVID, by identifying patterns and relationships of symptoms, predicting risk indicators, and enabling early evaluation of COVID-19 sequelae.
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Affiliation(s)
| | - Jorge González-Puelma
- Centro Asistencial Docente y de Investigación, Universidad de Magallanes, Punta Arenas, Chile
- Escuela de Medicina, Universidad de Magallanes, Punta Arenas, Chile
| | - David Medina-Ortiz
- Departamento de Ingeniería en Computación, Facultad de Ingeniería, Universidad de Magallanes, Punta Arenas, Chile
| | - Jacqueline Aldridge
- Departamento de Ingeniería en Computación, Facultad de Ingeniería, Universidad de Magallanes, Punta Arenas, Chile
| | - Diego Alvarez-Saravia
- Centro Asistencial Docente y de Investigación, Universidad de Magallanes, Punta Arenas, Chile
- Escuela de Medicina, Universidad de Magallanes, Punta Arenas, Chile
| | - Roberto Uribe-Paredes
- Departamento de Ingeniería en Computación, Facultad de Ingeniería, Universidad de Magallanes, Punta Arenas, Chile
| | - Marcelo A. Navarrete
- Centro Asistencial Docente y de Investigación, Universidad de Magallanes, Punta Arenas, Chile
- Escuela de Medicina, Universidad de Magallanes, Punta Arenas, Chile
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25
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Dijkstra S, Baas S, Braaksma A, Boucherie RJ. Dynamic fair balancing of COVID-19 patients over hospitals based on forecasts of bed occupancy. OMEGA 2023; 116:102801. [PMID: 36415506 PMCID: PMC9671547 DOI: 10.1016/j.omega.2022.102801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
This paper introduces mathematical models that support dynamic fair balancing of COVID-19 patients over hospitals in a region and across regions. Patient flow is captured in an infinite server queueing network. The dynamic fair balancing model within a region is a load balancing model incorporating a forecast of the bed occupancy, while across regions, it is a stochastic program taking into account scenarios of the future bed surpluses or shortages. Our dynamic fair balancing models yield decision rules for patient allocation to hospitals within the region and reallocation across regions based on safety levels and forecast bed surplus or bed shortage for each hospital or region. Input for the model is an accurate real-time forecast of the number of COVID-19 patients hospitalised in the ward and the Intensive Care Unit (ICU) of the hospitals based on the predicted inflow of patients, their Length of Stay and patient transfer probabilities among ward and ICU. The required data is obtained from the hospitals' data warehouses and regional infection data as recorded in the Netherlands. The algorithm is evaluated in Dutch regions for allocation of COVID-19 patients to hospitals within the region and reallocation across regions using data from the second COVID-19 peak.
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Affiliation(s)
- Sander Dijkstra
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, the Netherlands
| | - Stef Baas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, the Netherlands
| | - Aleida Braaksma
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, the Netherlands
| | - Richard J Boucherie
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, the Netherlands
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26
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Buttia C, Llanaj E, Raeisi-Dehkordi H, Kastrati L, Amiri M, Meçani R, Taneri PE, Ochoa SAG, Raguindin PF, Wehrli F, Khatami F, Espínola OP, Rojas LZ, de Mortanges AP, Macharia-Nimietz EF, Alijla F, Minder B, Leichtle AB, Lüthi N, Ehrhard S, Que YA, Fernandes LK, Hautz W, Muka T. Prognostic models in COVID-19 infection that predict severity: a systematic review. Eur J Epidemiol 2023; 38:355-372. [PMID: 36840867 PMCID: PMC9958330 DOI: 10.1007/s10654-023-00973-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
Current evidence on COVID-19 prognostic models is inconsistent and clinical applicability remains controversial. We performed a systematic review to summarize and critically appraise the available studies that have developed, assessed and/or validated prognostic models of COVID-19 predicting health outcomes. We searched six bibliographic databases to identify published articles that investigated univariable and multivariable prognostic models predicting adverse outcomes in adult COVID-19 patients, including intensive care unit (ICU) admission, intubation, high-flow nasal therapy (HFNT), extracorporeal membrane oxygenation (ECMO) and mortality. We identified and assessed 314 eligible articles from more than 40 countries, with 152 of these studies presenting mortality, 66 progression to severe or critical illness, 35 mortality and ICU admission combined, 17 ICU admission only, while the remaining 44 studies reported prediction models for mechanical ventilation (MV) or a combination of multiple outcomes. The sample size of included studies varied from 11 to 7,704,171 participants, with a mean age ranging from 18 to 93 years. There were 353 prognostic models investigated, with area under the curve (AUC) ranging from 0.44 to 0.99. A great proportion of studies (61.5%, 193 out of 314) performed internal or external validation or replication. In 312 (99.4%) studies, prognostic models were reported to be at high risk of bias due to uncertainties and challenges surrounding methodological rigor, sampling, handling of missing data, failure to deal with overfitting and heterogeneous definitions of COVID-19 and severity outcomes. While several clinical prognostic models for COVID-19 have been described in the literature, they are limited in generalizability and/or applicability due to deficiencies in addressing fundamental statistical and methodological concerns. Future large, multi-centric and well-designed prognostic prospective studies are needed to clarify remaining uncertainties.
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Affiliation(s)
- Chepkoech Buttia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Erand Llanaj
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
- ELKH-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Epistudia, Bern, Switzerland
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lum Kastrati
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mojgan Amiri
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Renald Meçani
- Department of Pediatrics, “Mother Teresa” University Hospital Center, Tirana, University of Medicine, Tirana, Albania
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Petek Eylul Taneri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- HRB-Trials Methodology Research Network College of Medicine, Nursing and Health Sciences University of Galway, Galway, Ireland
| | | | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Faina Wehrli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Octavio Pano Espínola
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Preventive Medicine and Public Health, University of Navarre, Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Lyda Z. Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia
| | | | | | - Fadi Alijla
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Alexander B. Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, and Center for Artificial Intelligence in Medicine (CAIM), University of Bern, Bern, Switzerland
| | - Nora Lüthi
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Simone Ehrhard
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurenz Kopp Fernandes
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf Hautz
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
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Tiwari S, Chanak P, Singh SK. A Review of the Machine Learning Algorithms for Covid-19 Case Analysis. IEEE TRANSACTIONS ON ARTIFICIAL INTELLIGENCE 2023; 4:44-59. [PMID: 36908643 PMCID: PMC9983698 DOI: 10.1109/tai.2022.3142241] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/25/2021] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Shrikant Tiwari
- Department of Computer Science and EngineeringIndian Institute of Technology (BHU) Varanasi 221005 India
| | - Prasenjit Chanak
- Department of Computer Science and EngineeringIndian Institute of Technology (BHU) Varanasi 221005 India
| | - Sanjay Kumar Singh
- Department of Computer Science and EngineeringIndian Institute of Technology (BHU) Varanasi 221005 India
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Mavragani A, Bozio C, Butterfield K, Reynolds S, Reese SE, Ball S, Steffens A, Demarco M, McEvoy C, Thompson M, Rowley E, Porter RM, Fink RV, Irving SA, Naleway A. Accuracy of COVID-19-Like Illness Diagnoses in Electronic Health Record Data: Retrospective Cohort Study. JMIR Form Res 2023; 7:e39231. [PMID: 36383633 PMCID: PMC9848441 DOI: 10.2196/39231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/13/2022] [Accepted: 09/30/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Electronic health record (EHR) data provide a unique opportunity to study the epidemiology of COVID-19, clinical outcomes of the infection, comparative effectiveness of therapies, and vaccine effectiveness but require a well-defined computable phenotype of COVID-19-like illness (CLI). OBJECTIVE The objective of this study was to evaluate the performance of pathogen-specific and other acute respiratory illness (ARI) International Statistical Classification of Diseases-9 and -10 codes in identifying COVID-19 cases in emergency department (ED) or urgent care (UC) and inpatient settings. METHODS We conducted a retrospective observational cohort study using EHR, claims, and laboratory information system data of ED or UC and inpatient encounters from 4 health systems in the United States. Patients who were aged ≥18 years, had an ED or UC or inpatient encounter for an ARI, and underwent a SARS-CoV-2 polymerase chain reaction test between March 1, 2020, and March 31, 2021, were included. We evaluated various CLI definitions using combinations of International Statistical Classification of Diseases-10 codes as follows: COVID-19-specific codes; CLI definition used in VISION network studies; ARI signs, symptoms, and diagnosis codes only; signs and symptoms of ARI only; and random forest model definitions. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of each CLI definition using a positive SARS-CoV-2 polymerase chain reaction test as the reference standard. We evaluated the performance of each CLI definition for distinct hospitalization and ED or UC cohorts. RESULTS Among 90,952 hospitalizations and 137,067 ED or UC visits, 5627 (6.19%) and 9866 (7.20%) were positive for SARS-CoV-2, respectively. COVID-19-specific codes had high sensitivity (91.6%) and specificity (99.6%) in identifying patients with SARS-CoV-2 positivity among hospitalized patients. The VISION CLI definition maintained high sensitivity (95.8%) but lowered specificity (45.5%). By contrast, signs and symptoms of ARI had low sensitivity and positive predictive value (28.9% and 11.8%, respectively) but higher specificity and negative predictive value (85.3% and 94.7%, respectively). ARI diagnoses, signs, and symptoms alone had low predictive performance. All CLI definitions had lower sensitivity for ED or UC encounters. Random forest approaches identified distinct CLI definitions with high performance for hospital encounters and moderate performance for ED or UC encounters. CONCLUSIONS COVID-19-specific codes have high sensitivity and specificity in identifying adults with positive SARS-CoV-2 test results. Separate combinations of COVID-19-specific codes and ARI codes enhance the utility of CLI definitions in studies using EHR data in hospital and ED or UC settings.
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Affiliation(s)
| | - Catherine Bozio
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Sue Reynolds
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Andrea Steffens
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Mark Thompson
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Rachael M Porter
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Stephanie A Irving
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Allison Naleway
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, United States
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Walston SL, Matsumoto T, Miki Y, Ueda D. Artificial intelligence-based model for COVID-19 prognosis incorporating chest radiographs and clinical data; a retrospective model development and validation study. Br J Radiol 2022; 95:20220058. [PMID: 36193755 PMCID: PMC9733620 DOI: 10.1259/bjr.20220058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University,1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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Dahn C, Maheshwari S, Stansky D, Smith S, Lee D. Unexpected ICU Transfer and Mortality in COVID-19 Related to Hospital Volume. West J Emerg Med 2022; 23:907-912. [DOI: 10.5811/westjem.2022.8.57035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/30/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Coronavirus 2019 (COVID-19) illness continues to affect national and global hospital systems, with a particularly high burden to intensive care unit (ICU) beds and resources. It is critical to identify patients who initially do not require ICU resources but subsequently rapidly deteriorate. We investigated patient populations during COVID-19 at times of full or near-full (surge) and non-full (non-surge) hospital capacity to determine the effect on those who may need a higher level of care or deteriorate quickly, defined as requiring a transfer to ICU within 24 hours of admission to a non-ICU level of care, and to provide further knowledge on this high-risk group of patients.
Methods: This was a retrospective cohort study of a single health system comprising four emergency departments and three tertiary hospitals in New York, NY, across two different time periods (during surge and non-surge inpatient volume times during the COVID-19 pandemic). We queried the electronic health record for all patients admitted to a non-ICU setting with unexpected ICU transfer (UIT) within 24 hours of admission. We then made a comparison between adult patients with confirmed coronavirus 2019 and without during surge and non-surge time periods.
Results: During the surge period, there was a total of 86 UITs in a one-month period. Of those, 60 were COVID-19 positive patients who had a mortality rate of 63.3%, and 26 were COVID-19 negative with a 30.8 % mortality rate. During the non-surge period, there was a total of 112 UITs; of those, 24 were COVID-19 positive with a 37.5% mortality rate, and 90 were COVID-19 negative with a 11.1% mortality rate.
Conclusion: During the surge, the mortality rate for both COVID-19 positive and COVID-19 negative patients experiencing an unexpected ICU transfer was significantly higher.
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Affiliation(s)
- Cassidy Dahn
- NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, Division of Critical Care, New York, New York
| | - Sana Maheshwari
- NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York
| | - Danielle Stansky
- NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York
| | - Silas Smith
- NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, Division of Medical Toxicology, New York, New York
| | - David Lee
- NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, Department of Population Health, New York, New York
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Chiu CC, Wu CM, Chien TN, Kao LJ, Li C, Jiang HL. Applying an Improved Stacking Ensemble Model to Predict the Mortality of ICU Patients with Heart Failure. J Clin Med 2022; 11:6460. [PMID: 36362686 PMCID: PMC9659015 DOI: 10.3390/jcm11216460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Cardiovascular diseases have been identified as one of the top three causes of death worldwide, with onset and deaths mostly due to heart failure (HF). In ICU, where patients with HF are at increased risk of death and consume significant medical resources, early and accurate prediction of the time of death for patients at high risk of death would enable them to receive appropriate and timely medical care. The data for this study were obtained from the MIMIC-III database, where we collected vital signs and tests for 6699 HF patient during the first 24 h of their first ICU admission. In order to predict the mortality of HF patients in ICUs more precisely, an integrated stacking model is proposed and applied in this paper. In the first stage of dataset classification, the datasets were subjected to first-level classifiers using RF, SVC, KNN, LGBM, Bagging, and Adaboost. Then, the fusion of these six classifier decisions was used to construct and optimize the stacked set of second-level classifiers. The results indicate that our model obtained an accuracy of 95.25% and AUROC of 82.55% in predicting the mortality rate of HF patients, which demonstrates the outstanding capability and efficiency of our method. In addition, the results of this study also revealed that platelets, glucose, and blood urea nitrogen were the clinical features that had the greatest impact on model prediction. The results of this analysis not only improve the understanding of patients' conditions by healthcare professionals but allow for a more optimal use of healthcare resources.
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Affiliation(s)
- Chih-Chou Chiu
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chung-Min Wu
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Te-Nien Chien
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Ling-Jing Kao
- Department of Business Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chengcheng Li
- College of Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Han-Ling Jiang
- Alliance Manchester Business School, University of Manchester, Manchester M15 6PB, UK
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Tariq A, Tang S, Sakhi H, Celi LA, Newsome JM, Rubin DL, Trivedi H, Gichoy JW, Patel B, Banerjee I. Graph-based Fusion Modeling and Explanation for Disease Trajectory Prediction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.10.25.22281469. [PMID: 36324799 PMCID: PMC9628192 DOI: 10.1101/2022.10.25.22281469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We propose a relational graph to incorporate clinical similarity between patients while building personalized clinical event predictors with a focus on hospitalized COVID-19 patients. Our graph formation process fuses heterogeneous data, i.e., chest X-rays as node features and non-imaging EHR for edge formation. While node represents a snap-shot in time for a single patient, weighted edge structure encodes complex clinical patterns among patients. While age and gender have been used in the past for patient graph formation, our method incorporates complex clinical history while avoiding manual feature selection. The model learns from the patient's own data as well as patterns among clinically-similar patients. Our visualization study investigates the effects of 'neighborhood' of a node on its predictiveness and showcases the model's tendency to focus on edge-connected patients with highly suggestive clinical features common with the node. The proposed model generalizes well by allowing edge formation process to adapt to an external cohort.
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Affiliation(s)
| | - Siyi Tang
- Department of Electrical Engineering, Stanford University
| | - Hifza Sakhi
- Philadelphia College of Osteopathic Medicine - Georgia Campus
| | | | | | | | - Hari Trivedi
- Department of Radiology and Imaging Sciences, Emory University, GA
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Neural-Symbolic Ensemble Learning for early-stage prediction of critical state of Covid-19 patients. Med Biol Eng Comput 2022; 60:3461-3474. [PMID: 36201136 PMCID: PMC9540054 DOI: 10.1007/s11517-022-02674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 09/17/2022] [Indexed: 11/11/2022]
Abstract
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. Representation of Neural HPLP. From top to bottom, the two different types of data collected from the same patient and used in this project are represented. This data feeds the two different machine learning systems and the integration of the two systems using Hierarchical Probabilistic Logic Program. ![]()
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Smit JM, Krijthe JH, Tintu AN, Endeman H, Ludikhuize J, van Genderen ME, Hassan S, El Moussaoui R, Westerweel PE, Goekoop RJ, Waverijn G, Verheijen T, den Hollander JG, de Boer MGJ, Gommers DAMPJ, van der Vlies R, Schellings M, Carels RA, van Nieuwkoop C, Arbous SM, van Bommel J, Knevel R, de Rijke YB, Reinders MJT. Development and validation of an early warning model for hospitalized COVID-19 patients: a multi-center retrospective cohort study. Intensive Care Med Exp 2022; 10:38. [PMID: 36117237 PMCID: PMC9482891 DOI: 10.1186/s40635-022-00465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Timely identification of deteriorating COVID-19 patients is needed to guide changes in clinical management and admission to intensive care units (ICUs). There is significant concern that widely used Early warning scores (EWSs) underestimate illness severity in COVID-19 patients and therefore, we developed an early warning model specifically for COVID-19 patients.
Methods We retrospectively collected electronic medical record data to extract predictors and used these to fit a random forest model. To simulate the situation in which the model would have been developed after the first and implemented during the second COVID-19 ‘wave’ in the Netherlands, we performed a temporal validation by splitting all included patients into groups admitted before and after August 1, 2020. Furthermore, we propose a method for dynamic model updating to retain model performance over time. We evaluated model discrimination and calibration, performed a decision curve analysis, and quantified the importance of predictors using SHapley Additive exPlanations values. Results We included 3514 COVID-19 patient admissions from six Dutch hospitals between February 2020 and May 2021, and included a total of 18 predictors for model fitting. The model showed a higher discriminative performance in terms of partial area under the receiver operating characteristic curve (0.82 [0.80–0.84]) compared to the National early warning score (0.72 [0.69–0.74]) and the Modified early warning score (0.67 [0.65–0.69]), a greater net benefit over a range of clinically relevant model thresholds, and relatively good calibration (intercept = 0.03 [− 0.09 to 0.14], slope = 0.79 [0.73–0.86]). Conclusions This study shows the potential benefit of moving from early warning models for the general inpatient population to models for specific patient groups. Further (independent) validation of the model is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00465-4.
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Affiliation(s)
- Jim M Smit
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands. .,EEMCS, Pattern Recognition and Bio-Informatics Group, Delft University of Technology, Delft, The Netherlands.
| | - Jesse H Krijthe
- EEMCS, Pattern Recognition and Bio-Informatics Group, Delft University of Technology, Delft, The Netherlands
| | - Andrei N Tintu
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Ludikhuize
- Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands.,General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Michel E van Genderen
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Shermarke Hassan
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rachida El Moussaoui
- Department of Internal Medicine, Maasstad Teaching Hospital, Rotterdam, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Teaching Hospital, Dordrecht, The Netherlands
| | - Robbert J Goekoop
- Department of Rheumatology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Geeke Waverijn
- Team Business Intelligence, Maasstad Teaching Hospital, Rotterdam, The Netherlands
| | - Tim Verheijen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstad Teaching Hospital, Rotterdam, The Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Robin van der Vlies
- Team Business Intelligence, Albert Schweitzer Teaching Hospital, Dordrecht, The Netherlands
| | - Mark Schellings
- Department of Clinical Chemistry, MaasstadLab, Maasstad Teaching Hospital, Rotterdam, The Netherlands
| | - Regina A Carels
- Department of Internal Medicine, Ikazia Teaching Hospital, Rotterdam, The Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sesmu M Arbous
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jasper van Bommel
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rachel Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Translational Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel J T Reinders
- EEMCS, Pattern Recognition and Bio-Informatics Group, Delft University of Technology, Delft, The Netherlands
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Chen J, Li Y, Guo L, Zhou X, Zhu Y, He Q, Han H, Feng Q. Machine learning techniques for CT imaging diagnosis of novel coronavirus pneumonia: a review. Neural Comput Appl 2022; 36:1-19. [PMID: 36159188 PMCID: PMC9483435 DOI: 10.1007/s00521-022-07709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Jingjing Chen
- Zhejiang University City College, Hangzhou, China
- Zhijiang College of Zhejiang University of Technology, Shaoxing, China
| | - Yixiao Li
- Faculty of Science, Zhejiang University of Technology, Hangzhou, China
| | - Lingling Guo
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Xiaokang Zhou
- Faculty of Data Science, Shiga University, Hikone, Japan
- RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Yihan Zhu
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Qingfeng He
- School of Pharmacy, Fudan University, Shanghai, China
| | - Haijun Han
- School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Qilong Feng
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China
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Luo MH, Huang DL, Luo JC, Su Y, Li JK, Tu GW, Luo Z. Data science in the intensive care unit. World J Crit Care Med 2022; 11:311-316. [PMID: 36160936 PMCID: PMC9483002 DOI: 10.5492/wjccm.v11.i5.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
In this editorial, we comment on the current development and deployment of data science in intensive care units (ICUs). Data in ICUs can be classified into qualitative and quantitative data with different technologies needed to translate and interpret them. Data science, in the form of artificial intelligence (AI), should find the right interaction between physicians, data and algorithm. For individual patients and physicians, sepsis and mechanical ventilation have been two important aspects where AI has been extensively studied. However, major risks of bias, lack of generalizability and poor clinical values remain. AI deployment in the ICUs should be emphasized more to facilitate AI development. For ICU management, AI has a huge potential in transforming resource allocation. The coronavirus disease 2019 pandemic has given opportunities to establish such systems which should be investigated further. Ethical concerns must be addressed when designing such AI.
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Affiliation(s)
- Ming-Hao Luo
- Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Dan-Lei Huang
- Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jing-Chao Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jia-Kun Li
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Caires Silveira E, Mattos Pretti S, Santos BA, Santos Corrêa CF, Madureira Silva L, Freire de Melo F. Prediction of hospital mortality in intensive care unit patients from clinical and laboratory data: A machine learning approach. World J Crit Care Med 2022; 11:317-329. [PMID: 36160934 PMCID: PMC9483004 DOI: 10.5492/wjccm.v11.i5.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/13/2021] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Elena Caires Silveira
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista 45-029094, Brazil
| | - Soraya Mattos Pretti
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista 45-029094, Brazil
| | - Bruna Almeida Santos
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista 45-029094, Brazil
| | - Caio Fellipe Santos Corrêa
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista 45-029094, Brazil
| | - Leonardo Madureira Silva
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista 45-029094, Brazil
| | - Fabrício Freire de Melo
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista 45-029094, Brazil
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Ramos-Hernández WM, Soto LF, Del Rosario-Trinidad M, Farfan-Morales CN, De Jesús-González LA, Martínez-Mier G, Osuna-Ramos JF, Bastida-González F, Bernal-Dolores V, Del Ángel RM, Reyes-Ruiz JM. Leukocyte glucose index as a novel biomarker for COVID-19 severity. Sci Rep 2022; 12:14956. [PMID: 36056114 PMCID: PMC9438363 DOI: 10.1038/s41598-022-18786-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
The severity of coronavirus disease 2019 (COVID-19) quickly progresses with unfavorable outcomes due to the host immune response and metabolism alteration. Hence, we hypothesized that leukocyte glucose index (LGI) is a biomarker for severe COVID-19. This study involved 109 patients and the usefulness of LGI was evaluated and compared with other risk factors to predict COVID 19 severity. LGI was identified as an independent risk factor (odds ratio [OR] = 1.727, 95% confidence interval [CI]: 1.026-3.048, P = 0.041), with an area under the curve (AUC) of 0.749 (95% CI: 0.642-0.857, P < 0.0001). Interestingly, LGI was a potential risk factor (OR = 2.694, 95% CI: 1.575-5.283, Pcorrected < 0.05) for severe COVID-19 in female but not in male patients. In addition, LGI proved to be a strong predictor of the severity in patients with diabetes (AUC = 0.915 (95% CI: 0.830-1), sensitivity = 0.833, and specificity = 0.931). The AUC of LGI, together with the respiratory rate (LGI + RR), showed a considerable improvement (AUC = 0.894, 95% CI: 0.835-0.954) compared to the other biochemical and respiratory parameters analyzed. Together, these findings indicate that LGI could potentially be used as a biomarker of severity in COVID-19 patients.
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Affiliation(s)
- Wendy Marilú Ramos-Hernández
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), 91897, Veracruz, México
| | - Luis F Soto
- Escuela Profesional de Genética y Biotecnología, Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Lima, 15081, Perú
| | - Marcos Del Rosario-Trinidad
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), 91897, Veracruz, México
| | - Carlos Noe Farfan-Morales
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), 07360, Mexico City, Mexico
| | - Luis Adrián De Jesús-González
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), 07360, Mexico City, Mexico
| | - Gustavo Martínez-Mier
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), 91897, Veracruz, México
| | - Juan Fidel Osuna-Ramos
- Escuela de Medicina, Universidad Autónoma de Durango Campus Culiacán, 80050, Culiacán Rosales, México
| | - Fernando Bastida-González
- Laboratorio de Biología Molecular, Laboratorio Estatal de Salud Pública del Estado de México, 50130, Mexico City, State of Mexico, Mexico
| | - Víctor Bernal-Dolores
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), 91897, Veracruz, México
| | - Rosa María Del Ángel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), 07360, Mexico City, Mexico.
| | - José Manuel Reyes-Ruiz
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), 91897, Veracruz, México.
- Facultad de Medicina, Región Veracruz, Universidad Veracruzana, 91700, Veracruz, Mexico.
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Besculides M, Mazumdar M, Phlegar S, Freeman R, Wilson S, Joshi H, Kia A, Gorbenko K. Implementing a Machine Learning Screening Tool for Malnutrition: Insights from Qualitative Research Applicable to Other ML-Based CDSS (Preprint). JMIR Form Res 2022. [PMID: 37440303 PMCID: PMC10375393 DOI: 10.2196/42262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Machine learning (ML)-based clinical decision support systems (CDSS) are popular in clinical practice settings but are often criticized for being limited in usability, interpretability, and effectiveness. Evaluating the implementation of ML-based CDSS is critical to ensure CDSS is acceptable and useful to clinicians and helps them deliver high-quality health care. Malnutrition is a common and underdiagnosed condition among hospital patients, which can have serious adverse impacts. Early identification and treatment of malnutrition are important. OBJECTIVE This study aims to evaluate the implementation of an ML tool, Malnutrition Universal Screening Tool (MUST)-Plus, that predicts hospital patients at high risk for malnutrition and identify best implementation practices applicable to this and other ML-based CDSS. METHODS We conducted a qualitative postimplementation evaluation using in-depth interviews with registered dietitians (RDs) who use MUST-Plus output in their everyday work. After coding the data, we mapped emergent themes onto select domains of the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. RESULTS We interviewed 17 of the 24 RDs approached (71%), representing 37% of those who use MUST-Plus output. Several themes emerged: (1) enhancements to the tool were made to improve accuracy and usability; (2) MUST-Plus helped identify patients that would not otherwise be seen; perceived usefulness was highest in the original site; (3) perceived accuracy varied by respondent and site; (4) RDs valued autonomy in prioritizing patients; (5) depth of tool understanding varied by hospital and level; (6) MUST-Plus was integrated into workflows and electronic health records; and (7) RDs expressed a desire to eventually have 1 automated screener. CONCLUSIONS Our findings suggest that continuous involvement of stakeholders at new sites given staff turnover is vital to ensure buy-in. Qualitative research can help identify the potential bias of ML tools and should be widely used to ensure health equity. Ongoing collaboration among CDSS developers, data scientists, and clinical providers may help refine CDSS for optimal use and improve the acceptability of CDSS in the clinical context.
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Nirmaladevi J, Vidhyalakshmi M, Edwin EB, Venkateswaran N, Avasthi V, Alarfaj AA, Hirad AH, Rajendran RK, Hailu T. Deep Convolutional Neural Network Mechanism Assessment of COVID-19 Severity. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1289221. [PMID: 36051480 PMCID: PMC9427302 DOI: 10.1155/2022/1289221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 12/23/2022]
Abstract
As an epidemic, COVID-19's core test instrument still has serious flaws. To improve the present condition, all capabilities and tools available in this field are being used to combat the pandemic. Because of the contagious characteristics of the unique coronavirus (COVID-19) infection, an overwhelming comparison with patients queues up for pulmonary X-rays, overloading physicians and radiology and significantly impacting the quality of care, diagnosis, and outbreak prevention. Given the scarcity of clinical services such as intensive care and motorized ventilation systems in the aspect of this vastly transmissible ailment, it is critical to categorize patients as per their risk categories. This research describes a novel use of the deep convolutional neural network (CNN) technique to COVID-19 illness assessment seriousness. Utilizing chest X-ray images as contribution, an unsupervised DCNN model is constructed and suggested to split COVID-19 individuals into four seriousness classrooms: low, medium, serious, and crucial with an accuracy level of 96 percent. The efficiency of the DCNN model developed with the proposed methodology is demonstrated by empirical findings on a suitably huge sum of chest X-ray scans. To the evidence relating, it is the first COVID-19 disease incidence evaluation research with four different phases, to use a reasonably high number of X-ray images dataset and a DCNN with nearly all hyperparameters dynamically adjusted by the variable selection optimization task.
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Affiliation(s)
- J. Nirmaladevi
- Department of Information Science and Engineering, Bannari Amman Institute of Technology, Sathyamangalam, Tamil Nadu 638401, India
| | - M. Vidhyalakshmi
- Department of Electronics and Communication Engineering, SRM Institute of Science and Technology, Ramapuram, Chennai, 600089 Tamil Nadu, India
| | - E. Bijolin Edwin
- Department of Computer Science and Engineering, KarunyaInstitue of Technology and Sciences, Coimbatore, Tamil Nadu 641114, India
| | - N. Venkateswaran
- Department of Management Studies, Panimalar Engineering College, Chennai, Tamil Nadu 600123, India
| | - Vinay Avasthi
- School of Computer Science, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
| | - Abdullah A. Alarfaj
- Department of Botany and Microbiology, College of Science, King Saud University, P. O. Box.2455, Riyadh 11451, Saudi Arabia
| | - Abdurahman Hajinur Hirad
- Department of Botany and Microbiology, College of Science, King Saud University, P. O. Box.2455, Riyadh 11451, Saudi Arabia
| | - R. K. Rajendran
- Department of Engineering, University of Houston, Texas, USA
| | - TegegneAyalew Hailu
- Department of Electrical and Computer Engineering, Kombolcha Institute of Technology, Wollo University, Ethiopia
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Başaran NÇ, Özdede M, Uyaroğlu OA, Şahin TK, Özcan B, Oral H, Özışık L, Güven GS, Tanrıöver MD. Independent predictors of in-hospital mortality and the need for intensive care in hospitalized non-critical COVID-19 patients: a prospective cohort study. Intern Emerg Med 2022; 17:1413-1424. [PMID: 35596104 PMCID: PMC9122556 DOI: 10.1007/s11739-022-02962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/25/2022] [Indexed: 12/15/2022]
Abstract
One of the most helpful strategies to deal with ongoing coronavirus pandemics is to use some prudence when treating patients infected with SARS-CoV-2. We aimed to evaluate the clinical, demographic, and laboratory parameters that might have predictive value for in-hospital mortality and the need for intensive care and build a model based on them. This study was a prospective, observational, single-center study including non-critical patients admitted to COVID-19 wards. Besides classical clinic-demographic features, basic laboratory parameters obtained on admission were tested, and then new models for each outcome were developed built on the most significant variables. Receiver operating characteristics (ROC) analyses were performed by calculating each model's probability. A total of 368 non-critical hospitalized patients were recruited, the need for ICU care was observed in 70 patients (19%). The total number of patients who died in either ICU or wards was 39 (10.6%). The first two models (based on clinical features and demographics) were developed to predict ICU and death, respectively; older age, male sex, active cancer, and low baseline saturation were noted to be independent predictors. The area under the curve values of the first two models were noted 0.878 and 0.882 (p < .001; confidence interval [CI] 95% [0.837-0.919], p < .001; CI 95% [0.844-0.922]). Following two models, the third and fourth were based on laboratory parameters with clinic-demographic features. Initial lower sodium and lower albumin levels were determined as independent factors in predicting the need for ICU care; higher blood urea nitrogen and lower albumin were independent factors in predicting in-hospital mortality. The area under the curve values of the third and fourth model was noted 0.938 and 0.929, respectively (p < .001; CI 95% [0.912-0.965], p < .001; CI 95% [0.895-962]). By integrating the widely available blood tests results with simple clinic demographic data, non-critical patients can be stratified according to their risk level. Such stratification is essential to filter the patients' non-critical underlying diseases and conditions that can obfuscate the physician's predictive capacity.
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Affiliation(s)
- Nursel Çalık Başaran
- Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Özdede
- Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oğuz Abdullah Uyaroğlu
- Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Taha Koray Şahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berşan Özcan
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Oral
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lale Özışık
- Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülay Sain Güven
- Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mine Durusu Tanrıöver
- Division of General Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Lazzarini N, Filippoupolitis A, Manzione P, Eleftherohorinou H. A machine learning model on Real World Data for predicting progression to Acute Respiratory Distress Syndrome (ARDS) among COVID-19 patients. PLoS One 2022; 17:e0271227. [PMID: 35901089 PMCID: PMC9333235 DOI: 10.1371/journal.pone.0271227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Identifying COVID-19 patients that are most likely to progress to a severe infection is crucial for optimizing care management and increasing the likelihood of survival. This study presents a machine learning model that predicts severe cases of COVID-19, defined as the presence of Acute Respiratory Distress Syndrome (ARDS) and highlights the different risk factors that play a significant role in disease progression. Methods A cohort composed of 289,351 patients diagnosed with COVID-19 in April 2020 was created using US administrative claims data from Oct 2015 to Jul 2020. For each patient, information about 817 diagnoses, were collected from the medical history ahead of COVID-19 infection. The primary outcome of the study was the presence of ARDS in the 4 months following COVID-19 infection. The study cohort was randomly split into training set used for model development, test set for model evaluation and validation set for real-world performance estimation. Results We analyzed three machine learning classifiers to predict the presence of ARDS. Among the algorithms considered, a Gradient Boosting Decision Tree had the highest performance with an AUC of 0.695 (95% CI, 0.679–0.709) and an AUPRC of 0.0730 (95% CI, 0.0676 – 0.0823), showing a 40% performance increase in performance against a baseline classifier. A panel of five clinicians was also used to compare the predictive ability of the model to that of clinical experts. The comparison indicated that our model is on par or outperforms predictions made by the clinicians, both in terms of precision and recall. Conclusion This study presents a machine learning model that uses patient claims history to predict ARDS. The risk factors used by the model to perform its predictions have been extensively linked to the severity of the COVID-19 in the specialized literature. The most contributing diagnosis can be easily retrieved in the patient clinical history and can be used for an early screening of infected patients. Overall, the proposed model could be a promising tool to deploy in a healthcare setting to facilitate and optimize the care of COVID-19 patients.
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Affiliation(s)
- Nicola Lazzarini
- Real World Analytics & AI, IQVIA, Cambridge, United Kingdom
- * E-mail:
| | | | - Pedro Manzione
- Strategic Analytics & Insights, IQVIA, Saint-Prex, Switzerland
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Associations between the COVID-19 Pandemic and Hospital Infrastructure Adaptation and Planning—A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138195. [PMID: 35805855 PMCID: PMC9266736 DOI: 10.3390/ijerph19138195] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022]
Abstract
The SARS-CoV-2 pandemic has put unprecedented pressure on the hospital sector around the world. It has shown the importance of preparing and planning in the future for an outbreak that overwhelms every aspect of a hospital on a rapidly expanding scale. We conducted a scoping review to identify, map, and systemize existing knowledge about the relationships between COVID-19 and hospital infrastructure adaptation and capacity planning worldwide. We searched the Web of Science, Scopus, and PubMed and hand-searched gray papers published in English between December 2019 and December 2021. A total of 106 papers were included: 102 empirical studies and four technical reports. Empirical studies entailed five reviews, 40 studies focusing on hospital infrastructure adaptation and planning during the pandemics, and 57 studies on modeling the hospital capacity needed, measured mostly by the number of beds. The majority of studies were conducted in high-income countries and published within the first year of the pandemic. The strategies adopted by hospitals can be classified into short-term (repurposing medical and non-medical buildings, remote adjustments, and establishment of de novo structures) and long-term (architectural and engineering modifications, hospital networks, and digital approaches). More research is needed, focusing on specific strategies and the quality assessment of the evidence.
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Pezoulas VC, Liontos A, Mylona E, Papaloukas C, Milionis O, Biros D, Kyriakopoulos C, Kostikas K, Milionis H, Fotiadis DI. Predicting the need for mechanical ventilation and mortality in hospitalized COVID-19 patients who received heparin. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1020-1023. [PMID: 36086001 DOI: 10.1109/embc48229.2022.9871261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although several studies have utilized AI (artificial intelligence)-based solutions to enhance the decision making for mechanical ventilation, as well as, for mortality in COVID-19, the extraction of explainable predictors regarding heparin's effect in intensive care and mortality has been left unresolved. In the present study, we developed an explainable AI (XAI) workflow to shed light into predictors for admission in the intensive care unit (ICU), as well as, for mortality across those hospitalized COVID-19 patients who received heparin. AI empowered classifiers, such as, the hybrid Extreme gradient boosting (HXGBoost) with customized loss functions were trained on time-series curated clinical data to develop robust AI models. Shapley additive explanation analysis (SHAP) was conducted to determine the positive or negative impact of the predictors in the model's output. The HXGBoost predicted the risk for intensive care and mortality with 0.84 and 0.85 accuracy, respectively. SHAP analysis indicated that the low percentage of lymphocytes at day 7 along with increased FiO2 at days 1 and 5, low SatO2 at days 3 and 7 increase the probability for mortality and highlight the positive effect of heparin administration at the early days of hospitalization for reducing mortality.
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Comito C, Pizzuti C. Artificial intelligence for forecasting and diagnosing COVID-19 pandemic: A focused review. Artif Intell Med 2022; 128:102286. [PMID: 35534142 PMCID: PMC8958821 DOI: 10.1016/j.artmed.2022.102286] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023]
Abstract
The outbreak of novel corona virus 2019 (COVID-19) has been treated as a public health crisis of global concern by the World Health Organization (WHO). COVID-19 pandemic hugely affected countries worldwide raising the need to exploit novel, alternative and emerging technologies to respond to the emergency created by the weak health-care systems. In this context, Artificial Intelligence (AI) techniques can give a valid support to public health authorities, complementing traditional approaches with advanced tools. This study provides a comprehensive review of methods, algorithms, applications, and emerging AI technologies that can be utilized for forecasting and diagnosing COVID-19. The main objectives of this review are summarized as follows. (i) Understanding the importance of AI approaches such as machine learning and deep learning for COVID-19 pandemic; (ii) discussing the efficiency and impact of these methods for COVID-19 forecasting and diagnosing; (iii) providing an extensive background description of AI techniques to help non-expert to better catch the underlying concepts; (iv) for each work surveyed, give a detailed analysis of the rationale behind the approach, highlighting the method used, the type and size of data analyzed, the validation method, the target application and the results achieved; (v) focusing on some future challenges in COVID-19 forecasting and diagnosing.
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Sabetian G, Azimi A, Kazemi A, Hoseini B, Asmarian N, Khaloo V, Zand F, Masjedi M, Shahriarirad R, Shahriarirad S. Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study Based on Machine-learning Approach from Iran. Indian J Crit Care Med 2022; 26:688-695. [PMID: 35836646 PMCID: PMC9237161 DOI: 10.5005/jp-journals-10071-24226] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Golnar Sabetian
- Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran
| | - Aram Azimi
- Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran
- Aram Azimi, Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran, e-mail:
| | - Azar Kazemi
- Department of Biomedical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran
- Azar Kazemi, Department of Biomedical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran,
| | - Benyamin Hoseini
- Mashhad University of Medical Sciences, Pharmaceutical Research Center, Mashhad, Razavi Khorasan Province, Iran
| | | | - Vahid Khaloo
- Shiraz University of Medical Sciences, Aliasghar Hospital, Shiraz, Iran
| | - Farid Zand
- Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran
| | - Mansoor Masjedi
- Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran
| | - Reza Shahriarirad
- Shiraz University of Medical Sciences, Thoracic and Vascular Surgery Research Center, Shiraz, Iran
| | - Sepehr Shahriarirad
- Shiraz University of Medical Sciences, Student Research Committee, Shiraz, Iran
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Föll S, Lison A, Maritsch M, Klingberg K, Lehmann V, Züger T, Srivastava D, Jegerlehner S, Feuerriegel S, Fleisch E, Exadaktylos A, Wortmann F. A Scalable Risk Scoring System for COVID-19 Inpatients Based on Consumer-grade Wearables: Statistical Analysis and Model Development. JMIR Form Res 2022; 6:e35717. [PMID: 35613417 PMCID: PMC9217156 DOI: 10.2196/35717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background To provide effective care for inpatients with COVID-19, clinical practitioners need systems that monitor patient health and subsequently allow for risk scoring. Existing approaches for risk scoring in patients with COVID-19 focus primarily on intensive care units (ICUs) with specialized medical measurement devices but not on hospital general wards. Objective In this paper, we aim to develop a risk score for inpatients with COVID-19 in general wards based on consumer-grade wearables (smartwatches). Methods Patients wore consumer-grade wearables to record physiological measurements, such as the heart rate (HR), heart rate variability (HRV), and respiration frequency (RF). Based on Bayesian survival analysis, we validated the association between these measurements and patient outcomes (ie, discharge or ICU admission). To build our risk score, we generated a low-dimensional representation of the physiological features. Subsequently, a pooled ordinal regression with time-dependent covariates inferred the probability of either hospital discharge or ICU admission. We evaluated the predictive performance of our developed system for risk scoring in a single-center, prospective study based on 40 inpatients with COVID-19 in a general ward of a tertiary referral center in Switzerland. Results First, Bayesian survival analysis showed that physiological measurements from consumer-grade wearables are significantly associated with patient outcomes (ie, discharge or ICU admission). Second, our risk score achieved a time-dependent area under the receiver operating characteristic curve (AUROC) of 0.73-0.90 based on leave-one-subject-out cross-validation. Conclusions Our results demonstrate the effectiveness of consumer-grade wearables for risk scoring in inpatients with COVID-19. Due to their low cost and ease of use, consumer-grade wearables could enable a scalable monitoring system. Trial Registration Clinicaltrials.gov NCT04357834; https://www.clinicaltrials.gov/ct2/show/NCT04357834
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Affiliation(s)
- Simon Föll
- Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH
| | - Adrian Lison
- Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH
| | - Martin Maritsch
- Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH
| | - Karsten Klingberg
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, Bern, CH
| | - Vera Lehmann
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, CH
| | - Thomas Züger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, CH.,Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH
| | - David Srivastava
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, Bern, CH
| | - Sabrina Jegerlehner
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, Bern, CH
| | - Stefan Feuerriegel
- Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH.,Institute of AI in Management, LMU Munich, Munich, DE
| | - Elgar Fleisch
- Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH.,Institute of Technology Management, University of St. Gallen, St. Gallen, CH
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, Bern, CH
| | - Felix Wortmann
- Institute of Technology Management, University of St. Gallen, St. Gallen, CH.,Department of Management, Technology, and Economics, ETH Zürich, Zürich, CH
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Bakhtiarvand N, Khashei M, Mahnam M, Hajiahmadi S. A novel reliability-based regression model to analyze and forecast the severity of COVID-19 patients. BMC Med Inform Decis Mak 2022; 22:123. [PMID: 35513811 PMCID: PMC9069125 DOI: 10.1186/s12911-022-01861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background Coronavirus outbreak (SARS-CoV-2) has become a serious threat to human society all around the world. Due to the rapid rate of disease outbreaks and the severe shortages of medical resources, predicting COVID-19 disease severity continues to be a challenge for healthcare systems. Accurate prediction of severe patients plays a vital role in determining treatment priorities, effective management of medical facilities, and reducing the number of deaths. Various methods have been used in the literature to predict the severity prognosis of COVID-19 patients. Despite the different appearance of the methods, they all aim to achieve generalizable results by increasing the accuracy and reducing the errors of predictions. In other words, accuracy is considered the only effective factor in the generalizability of models. In addition to accuracy, reliability and consistency of results are other critical factors that must be considered to yield generalizable medical predictions. Since the role of reliability in medical decisions is significant, upgrading reliable medical data-driven models requires more attention. Methods This paper presents a new modeling technique to specify and maximize the reliability of results in predicting the severity prognosis of COVID-19 patients. We use the well-known classic regression as the basic model to implement our proposed procedure on it. To assess the performance of the proposed model, it has been applied to predict the severity prognosis of COVID-19 by using a dataset including clinical information of 46 COVID-19 patients. The dataset consists of two types of patients’ outcomes including mild (discharge) and severe (ICU or death). To measure the efficiency of the proposed model, we compare the accuracy of the proposed model to the classic regression model. Results The proposed reliability-based regression model, by achieving 98.6% sensitivity, 88.2% specificity, and 93.10% accuracy, has better performance than classic accuracy-based regression model with 95.7% sensitivity, 85.5% specificity, and 90.3% accuracy. Also, graphical analysis of ROC curve showed AUC 0.93 (95% CI 0.88–0.98) and AUC 0.90 (95% CI 0.85–0.96) for classic regression models, respectively. Conclusions Maximizing reliability in the medical forecasting models can lead to more generalizable and accurate results. The competitive results indicate that the proposed reliability-based regression model has higher performance in predicting the deterioration of COVID-19 patients compared to the classic accuracy-based regression model. The proposed framework can be used as a suitable alternative for the traditional regression method to improve the decision-making and triage processes of COVID-19 patients.
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Affiliation(s)
- Negar Bakhtiarvand
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Mehdi Khashei
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.,Center for Optimization and Intelligent Decision Making in Healthcare Systems (COID-Health), Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Mehdi Mahnam
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran. .,Center for Optimization and Intelligent Decision Making in Healthcare Systems (COID-Health), Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Somayeh Hajiahmadi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim HJ, Heo J, Han D, Oh HS. Validation of Machine Learning Models to Predict Adverse Outcomes in Patients with COVID-19: A Prospective Pilot Study. Yonsei Med J 2022; 63:422-429. [PMID: 35512744 PMCID: PMC9086701 DOI: 10.3349/ymj.2022.63.5.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We previously developed learning models for predicting the need for intensive care and oxygen among patients with coronavirus disease (COVID-19). Here, we aimed to prospectively validate the accuracy of these models. MATERIALS AND METHODS Probabilities of the need for intensive care [intensive care unit (ICU) score] and oxygen (oxygen score) were calculated from information provided by hospitalized COVID-19 patients (n=44) via a web-based application. The performance of baseline scores to predict 30-day outcomes was assessed. RESULTS Among 44 patients, 5 and 15 patients needed intensive care and oxygen, respectively. The area under the curve of ICU score and oxygen score to predict 30-day outcomes were 0.774 [95% confidence interval (CI): 0.614-0.934] and 0.728 (95% CI: 0.559-0.898), respectively. The ICU scores of patients needing intensive care increased daily by 0.71 points (95% CI: 0.20-1.22) after hospitalization and by 0.85 points (95% CI: 0.36-1.35) after symptom onset, which were significantly different from those in individuals not needing intensive care (p=0.002 and <0.001, respectively). Trends in daily oxygen scores overall were not markedly different; however, when the scores were evaluated within <7 days after symptom onset, the patients needing oxygen showed a higher daily increase in oxygen scores [1.81 (95% CI: 0.48-3.14) vs. -0.28 (95% CI: 1.00-0.43), p=0.007]. CONCLUSION Our machine learning models showed good performance for predicting the outcomes of COVID-19 patients and could thus be useful for patient triage and monitoring.
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Affiliation(s)
- Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- The Armed Forces Medical Command, Seongnam, Korea
| | - Deokjae Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hong Sang Oh
- Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
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Kuo KM, Talley PC, Chang CS. The Accuracy of Machine Learning Approaches Using Non-image Data for the Prediction of COVID-19: A Meta-Analysis. Int J Med Inform 2022; 164:104791. [PMID: 35594810 PMCID: PMC9098530 DOI: 10.1016/j.ijmedinf.2022.104791] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022]
Abstract
Objective COVID-19 is a novel, severely contagious disease with enormous negative impact on humanity as well as the world economy. An expeditious, feasible tool for detecting COVID-19 remains yet elusive. Recently, there has been a surge of interest in applying machine learning techniques to predict COVID-19 using non-image data. We have therefore undertaken a meta-analysis to quantify the diagnostic performance of machine learning models facilitating the prediction of COVID-19. Materials and methods A comprehensive electronic database search for the period between January 1st, 2021 and December 3rd, 2021 was undertaken in order to identify eligible studies relevant to this meta-analysis. Summary sensitivity, specificity, and the area under receiver operating characteristic curves were used to assess potential diagnostic accuracy. Risk of bias was assessed by means of a revised Quality Assessment of Diagnostic Studies. Results A total of 30 studies, including 34 models, met all of the inclusion criteria. Summary sensitivity, specificity, and area under receiver operating characteristic curves were 0.86, 0.86, and 0.91, respectively. The purpose of machine learning models, class imbalance, and feature selection are significant covariates useful in explaining the between-study heterogeneity, in terms of both sensitivity and specificity. Conclusions Our study findings show that non-image data can be used to predict COVID-19 with an acceptable performance. Further, class imbalance and feature selection are suggested to be incorporated whenever building models for the prediction of COVID-19, thus improving further diagnostic performance.
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