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Explainable Machine Learning for Early Assessment of COVID-19 Risk Prediction in Emergency Departments.

ABSTRACT: Between January and October of 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has infected more than 34 million persons in a worldwide pandemic leading to over one million deaths worldwide (data from the Johns Hopkins University). Since the virus begun to spread, emergency departments were busy with COVID-19 patients for whom a quick decision regarding in- or outpatient care was required. The virus can cause characteristic abnormalities in chest radiographs (CXR), but, due to the low sensitivity of CXR, additional variables and criteria are needed to accurately predict risk. Here, we describe a computerized system primarily aimed at extracting the most relevant radiological, clinical, and laboratory variables for improving patient risk prediction, and secondarily at presenting an explainable machine learning system, which may provide simple decision criteria to be used by clinicians as a support for assessing patient risk. To achieve robust and reliable variable selection, Boruta and Random Forest (RF) are combined in a 10-fold cross-validation scheme to produce a variable importance estimate not biased by the presence of surrogates. The most important variables are then selected to train a RF classifier, whose rules may be extracted, simplified, and pruned to finally build an associative tree, particularly appealing for its simplicity. Results show that the radiological score automatically computed through a neural network is highly correlated with the score computed by radiologists, and that laboratory variables, together with the number of comorbidities, aid risk prediction. The prediction performance of our approach was compared to that that of generalized linear models and shown to be effective and robust. The proposed machine learning-based computational system can be easily deployed and used in emergency departments for rapid and accurate risk prediction in COVID-19 patients.

SUBMITTER: Casiraghi E

PROVIDER: S-EPMC8545262 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Since its emergence in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic with more than 55 million reported cases and 1.3 million estimated deaths worldwide. While epidemiological and clinical characteristics of COVID-19 have been reported, risk factors underlying the transition from mild to severe disease among patients remain poorly understood. In this retrospective study, we analysed data of 879 confirmed SARS-CoV-2 positive patients admitted to a two-site NHS Trust hospital in London, England, between January 1st and May 26th, 2020, with a majority of cases occurring in March and April. We extracted anonymised demographic data, physiological clinical variables and laboratory results from electronic healthcare records (EHR) and applied multivariate logistic regression, random forest and extreme gradient boosted trees. To evaluate the potential for early risk assessment, we used data available during patients' initial presentation at the emergency department (ED) to predict deterioration to one of three clinical endpoints in the remainder of the hospital stay: admission to intensive care, need for invasive mechanical ventilation and in-hospital mortality. Based on the trained models, we extracted the most informative clinical features in determining these patient trajectories. Considering our inclusion criteria, we have identified 129 of 879 (15%) patients that required intensive care, 62 of 878 (7%) patients needing mechanical ventilation, and 193 of 619 (31%) cases of in-hospital mortality. Our models learned successfully from early clinical data and predicted clinical endpoints with high accuracy, the best model achieving area under the receiver operating characteristic (AUC-ROC) scores of 0.76 to 0.87 (F1 scores of 0.42-0.60). Younger patient age was associated with an increased risk of receiving intensive care and ventilation, but lower risk of mortality. Clinical indicators of a patient's oxygen supply and selected laboratory results, such as blood lactate and creatinine levels, were most predictive of COVID-19 patient trajectories. Among COVID-19 patients machine learning can aid in the early identification of those with a poor prognosis, using EHR data collected during a patient's first presentation at ED. Patient age and measures of oxygenation status during ED stay are primary indicators of poor patient outcomes.

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Explainable Machine Learning for Early Assessment of COVID-19 Risk Prediction in Emergency Departments.

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