Abstract
In Coronavirus disease 2019 (COVID-19), early identification of patients with a high risk of mortality can significantly improve triage, bed allocation, timely management, and possibly, outcome. The study objective is to develop and validate individualized mortality risk scores based on the anonymized clinical and laboratory data at admission and determine the probability of Deaths at 7 and 28 days. Data of 1393 admitted patients (Expired—8.54%) was collected from six Apollo Hospital centers (from April to July 2020) using a standardized template and electronic medical records. 63 Clinical and Laboratory parameters were studied based on the patient’s initial clinical state at admission and laboratory parameters within the first 24 h. The Machine Learning (ML) modelling was performed using eXtreme Gradient Boosting (XGB) Algorithm. ‘Time to event’ using Cox Proportional Hazard Model was used and combined with XGB Algorithm. The prospective validation cohort was selected of 977 patients (Expired—8.3%) from six centers from July to October 2020. The Clinical API for the Algorithm is http://20.44.39.47/covid19v2/page1.php being used prospectively. Out of the 63 clinical and laboratory parameters, Age [adjusted hazard ratio (HR) 2.31; 95% CI 1.52–3.53], Male Gender (HR 1.72, 95% CI 1.06–2.85), Respiratory Distress (HR 1.79, 95% CI 1.32–2.53), Diabetes Mellitus (HR 1.21, 95% CI 0.83–1.77), Chronic Kidney Disease (HR 3.04, 95% CI 1.72–5.38), Coronary Artery Disease (HR 1.56, 95% CI − 0.91 to 2.69), respiratory rate > 24/min (HR 1.54, 95% CI 1.03–2.3), oxygen saturation below 90% (HR 2.84, 95% CI 1.87–4.3), Lymphocyte% in DLC (HR 1.99, 95% CI 1.23–2.32), INR (HR 1.71, 95% CI 1.31–2.13), LDH (HR 4.02, 95% CI 2.66–6.07) and Ferritin (HR 2.48, 95% CI 1.32–4.74) were found to be significant. The performance parameters of the current model is at AUC ROC Score of 0.8685 and Accuracy Score of 96.89. The validation cohort had the AUC of 0.782 and Accuracy of 0.93. The model for Mortality Risk Prediction provides insight into the COVID Clinical and Laboratory Parameters at admission. It is one of the early studies, reflecting on ‘time to event’ at the admission, accurately predicting patient outcomes.
Highlights
The current Coronavirus Disease (COVID)-19 pandemic caused by SARS-CoV-2 is associated with high mortality and morbidity[1]
Due to the absence of similar studies in the Indian population, this research work was undertaken to develop and validate Machine Learning Algorithms (MLA) based on the anonymized clinical and laboratory data to predict the outcome (Expired or Recovered) from retrospective evaluation of patients admitted with COVID (Fig. 1)
Further to the Hazard Ratios analysis of individual clinical and laboratory predictors, we looked at the predictors’ feature in survivability analysis using Kaplan Meier (KM) Plots
Summary
The current COVID-19 pandemic caused by SARS-CoV-2 is associated with high mortality and morbidity[1]. The datasets of COVID-19 patients can be integrated and analysed by Machine Learning (ML) algorithms to improve diagnostic speed and accuracy better and potentially identify the most susceptible people based on personalized clinical and laboratory characteristics[7]. These methods activate early insights of patient’s outcome with the predictors at the time of admission. The algorithm determines the probability (risk) of Events (defined as Death or Expiry of Subjects), predicting mortality at 7 and 28 days This would provide clinical insights on various clinical and laboratory parameters. These are clinically and statistically relevant and help develop a Clinical API (application and programming interface) tool used by clinicians taking care of admitted patients even in low-cost settings
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