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D’Agostini C, Legramante JM, Minieri M, Di Lecce VN, Lia MS, Maurici M, Simonelli I, Ciotti M, Paganelli C, Terrinoni A, Giovannelli A, Pieri M, Gallù M, Dell’Olio V, Prezioso C, Limongi D, Bernardini S, Orlacchio A. Correlation between Chest Computed Tomography Score and Laboratory Biomarkers in the Risk Stratification of COVID-19 Patients Admitted to the Emergency Department. Diagnostics (Basel) 2023; 13:2829. [PMID: 37685368 PMCID: PMC10486389 DOI: 10.3390/diagnostics13172829] [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: 07/12/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND It has been reported that mid-regional proadrenomedullin (MR-proADM) could be considered a useful tool to stratify the mortality risk in COVID-19 patients upon admission to the emergency department (ED). During the COVID-19 outbreak, computed tomography (CT) scans were widely used for their excellent sensitivity in diagnosing pneumonia associated with SARS-CoV-2 infection. However, the possible role of CT score in the risk stratification of COVID-19 patients upon admission to the ED is still unclear. AIM The main objective of this study was to assess if the association of the CT findings alone or together with MR-proADM results could ameliorate the prediction of in-hospital mortality of COVID-19 patients at the triage. Moreover, the hypothesis that CT score and MR-proADM levels together could play a key role in predicting the correct clinical setting for these patients was also evaluated. METHODS Epidemiological, demographic, clinical, laboratory, and outcome data were assessed and analyzed from 265 consecutive patients admitted to the triage of the ED with a SARS-CoV-2 infection. RESULTS AND CONCLUSIONS The accuracy results by AUROC analysis and statistical analysis demonstrated that CT score is particularly effective, when utilized together with the MR-proADM level, in the risk stratification of COVID-19 patients admitted to the ED, thus helping the decision-making process of emergency physicians and optimizing the hospital resources.
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Affiliation(s)
- Cartesio D’Agostini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (C.D.); (A.T.); (M.P.); (S.B.)
- Laboratory of Microbiology, Polyclinic of “Tor Vergata”, 00133 Rome, Italy
| | - Jacopo M. Legramante
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (J.M.L.); (M.G.)
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy; (V.N.D.L.); (C.P.)
| | - Marilena Minieri
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (C.D.); (A.T.); (M.P.); (S.B.)
- Unit of Laboratory Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (M.S.L.); (A.G.)
| | - Vito N. Di Lecce
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy; (V.N.D.L.); (C.P.)
| | - Maria Stella Lia
- Unit of Laboratory Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (M.S.L.); (A.G.)
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Ilaria Simonelli
- Nursing Science and Public Health, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Marco Ciotti
- Unit of Virology, Tor Vergata University Hospital, 00133 Rome, Italy;
| | - Carla Paganelli
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy; (V.N.D.L.); (C.P.)
| | - Alessandro Terrinoni
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (C.D.); (A.T.); (M.P.); (S.B.)
- Unit of Laboratory Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (M.S.L.); (A.G.)
| | - Alfredo Giovannelli
- Unit of Laboratory Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (M.S.L.); (A.G.)
| | - Massimo Pieri
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (C.D.); (A.T.); (M.P.); (S.B.)
- Unit of Laboratory Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (M.S.L.); (A.G.)
| | - Mariacarla Gallù
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (J.M.L.); (M.G.)
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy; (V.N.D.L.); (C.P.)
| | - Vito Dell’Olio
- Department of Surgical Science, University of Rome Tor Vergata, 00133 Rome, Italy; (V.D.); (A.O.)
- Emergency Radiology Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Carla Prezioso
- Laboratory of Microbiology of Chronic-Neurodegenerative Diseases, IRCCS San Raffaele Roma, 00166 Rome, Italy;
| | - Dolores Limongi
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, 00166 Rome, Italy;
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (C.D.); (A.T.); (M.P.); (S.B.)
- Unit of Laboratory Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (M.S.L.); (A.G.)
| | - Antonio Orlacchio
- Department of Surgical Science, University of Rome Tor Vergata, 00133 Rome, Italy; (V.D.); (A.O.)
- Emergency Radiology Unit, Tor Vergata University Hospital, 00133 Rome, Italy
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2
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Mihajlović A, Ivanov D, Tapavički B, Marković M, Vukas D, Miljković A, Bajić D, Semnic I, Bogdan M, Karaba Jakovljević D, Nikolić S, Slavić D, Lendak D. Prognostic Value of Routine Biomarkers in the Early Stage of COVID-19. Healthcare (Basel) 2023; 11:2137. [PMID: 37570378 PMCID: PMC10418955 DOI: 10.3390/healthcare11152137] [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: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Various biomarkers like certain complete blood cell count parameters and the derived ratios including neutrophil-lymphocyte ratio are commonly used to evaluate disease severity. Our study aimed to establish if baseline levels of complete blood cell count-derived biomarkers and CRP, measured before any treatment which can interfere with their values, could serve as a predictor of development of pneumonia and the need for hospitalization requiring oxygen therapy. We retrospectively analyzed the laboratory data of 200 consecutive patients without comorbidities, who denied usage of medications prior to blood analysis and visited a COVID-19 ambulance between October and December 2021. Multivariate regression analysis extracted older age, elevated CRP and lower eosinophil count as significant independent predictors of pneumonia (p = 0.003, p = 0.000, p = 0.046, respectively). Independent predictors of hospitalization were higher CRP (p = 0.000) and lower platelet count (p = 0.005). There was no significant difference in the neutrophil-lymphocyte and platelet-lymphocyte ratios between examined groups. Individual biomarkers such as platelet and eosinophil count might be better in predicting the severity of COVID-19 than the neutrophil-lymphocyte and platelet-lymphocyte ratios.
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Affiliation(s)
- Andrea Mihajlović
- Department of Physiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - David Ivanov
- Department of Physiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - Borislav Tapavički
- Department of Physiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - Milica Marković
- Health Centre Novi Sad, Bulevar Cara Lazara 75, 21102 Novi Sad, Serbia
| | - Dragana Vukas
- Health Centre Novi Sad, Bulevar Cara Lazara 75, 21102 Novi Sad, Serbia
| | - Ana Miljković
- Health Centre Novi Sad, Bulevar Cara Lazara 75, 21102 Novi Sad, Serbia
- Department of General Medicine and Geriatrics, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - Dejana Bajić
- Department of Biochemistry, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - Isidora Semnic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
- Clinic of Anesthesia and Intensive Care, University Clinical Center of Vojvodina, Hajduk Veljkova 1, 21137 Novi Sad, Serbia
| | - Maja Bogdan
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, Put Dr Goldmana Street 4, 21204 Sremska Kamenica, Serbia
| | - Dea Karaba Jakovljević
- Department of Physiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - Stanislava Nikolić
- Department of Pathophysiology and Laboratory Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
- Center of Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21137 Novi Sad, Serbia
| | - Danijel Slavić
- Department of Physiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
| | - Dajana Lendak
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia
- Clinic for Infectious Diseases, University Clinical Center of Vojvodina, Hajduk Veljkova 1, 21137 Novi Sad, Serbia
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3
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Bayraktar M, Tekin E, Kocak MN. How to diagnose COVID-19 in family practice? Usability of complete blood count as a COVID-19 diagnostic tool: a cross-sectional study in Turkey. BMJ Open 2023; 13:e069493. [PMID: 37068894 PMCID: PMC10111184 DOI: 10.1136/bmjopen-2022-069493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE COVID-19 is currently diagnosed in hospital settings. An easy and practical diagnosis of COVID-19 is needed in primary care. For this purpose, the usability of complete blood count in the diagnosis of COVID-19 was investigated. DESIGN Retrospective, cross-sectional study. SETTING Single-centre study in a tertiary university hospital in Erzurum, Turkey. PARTICIPANTS Between March 2020 and February 2021, patients aged 18-70 years who applied to the hospital and underwent both complete blood count and reverse-transcription-PCR tests for COVID-19 were included and compared. Conditions affecting the test parameters (oncological-haematological conditions, chronic diseases, drug usage) were excluded. OUTCOME MEASURE The complete blood count and COVID-19 results of eligible patients identified using diagnostic codes [U07.3 (COVID-19) or Z03.8 (observation for other suspected diseases and conditions)] were investigated. RESULTS Of the 978 patients included, 39.4% (n=385) were positive for COVID-19 and 60.6% (n=593) were negative. The mean age was 41.5±14.5 years, and 53.9% (n=527) were male. COVID-19-positive patients were found to have significantly lower leucocyte, neutrophil, lymphocyte, monocyte, basophil, platelet and immature granulocyte (IG) values (p<0.001). Neutrophil/lymphocyte, neutrophil/monocyte and IG/lymphocyte ratios were also found to be significantly decreased (p<0.001). With logistic regression analysis, low lymphocyte count (OR 0.695; 95% CI 0.597 to 0.809) and low red cell distribution width-coefficient of variation (RDW-CV) (OR 0.887; 95% CI 0.818 to 0.962) were significantly associated with COVID-19 positivity. In receiver operating characteristic analysis, the cut-off values of lymphocyte and RDW-CV were 0.745 and 12.35, respectively. CONCLUSION Although our study was designed retrospectively and reflects regional data, it is important to determine that low lymphocyte count and RDW-CV can be used in the diagnosis of COVID-19 in primary care.
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Affiliation(s)
| | - Erdal Tekin
- Emergency Medicine, Ataturk University, Erzurum, Turkey
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4
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Minieri M, Di Lecce VN, Lia MS, Maurici M, Leonardis F, Longo S, Colangeli L, Paganelli C, Levantesi S, Terrinoni A, Malagnino V, Brunetti DJ, Giovannelli A, Pieri M, Ciotti M, D’Agostini C, Gabriele M, Bernardini S, Legramante JM. Predictive Value of MR-proADM in the Risk Stratification and in the Adequate Care Setting of COVID-19 Patients Assessed at the Triage of the Emergency Department. Diagnostics (Basel) 2022; 12:diagnostics12081971. [PMID: 36010321 PMCID: PMC9406922 DOI: 10.3390/diagnostics12081971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
In the past two pandemic years, Emergency Departments (ED) have been overrun with COVID-19-suspicious patients. Some data on the role played by laboratory biomarkers in the early risk stratification of COVID-19 patients have been recently published. The aim of this study is to assess the potential role of the new biomarker mid-regional proadrenomedullin (MR-proADM) in stratifying the in-hospital mortality risk of COVID-19 patients at the triage. A further goal of the present study is to evaluate whether MR-proADM together with other biochemical markers could play a key role in assessing the correct care level of these patients. Data from 321 consecutive patients admitted to the triage of the ED with a COVID-19 infection were analyzed. Epidemiological; demographic; clinical; laboratory; and outcome data were assessed. All the biomarkers analyzed showed an important role in predicting mortality. In particular, an increase of MR-proADM level at ED admission was independently associated with a threefold higher risk of IMV. MR-proADM showed greater ROC curves and AUC when compared to other laboratory biomarkers for the primary endpoint such as in-hospital mortality, except for CRP. This study shows that MR-proADM seems to be particularly effective for early predicting mortality and the need of ventilation in COVID-19 patients admitted to the ED.
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Affiliation(s)
- Marilena Minieri
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-20902365
| | - Vito N. Di Lecce
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Maria Stella Lia
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Leonardis
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
- Intensive Care Unit, Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Susanna Longo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Carla Paganelli
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Stefania Levantesi
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Alessandro Terrinoni
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Vincenzo Malagnino
- Infectious Disease Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Domenico J. Brunetti
- Anaesthesia and Intensive Care Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Alfredo Giovannelli
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Massimo Pieri
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Marco Ciotti
- Virology Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Cartesio D’Agostini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Clinical Microbiology Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Mariachiara Gabriele
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Respiratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Jacopo M. Legramante
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Infectious Disease Unit, Tor Vergata University Hospital, 00133 Rome, Italy
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5
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Zuin G, Araujo D, Ribeiro V, Seiler MG, Prieto WH, Pintão MC, Dos Santos Lazari C, Granato CFH, Veloso A. Prediction of SARS-CoV-2-positivity from million-scale complete blood counts using machine learning. COMMUNICATIONS MEDICINE 2022; 2:72. [PMID: 35721829 PMCID: PMC9199341 DOI: 10.1038/s43856-022-00129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/23/2022] [Indexed: 01/10/2023] Open
Abstract
Background The Complete Blood Count (CBC) is a commonly used low-cost test that measures white blood cells, red blood cells, and platelets in a person’s blood. It is a useful tool to support medical decisions, as intrinsic variations of each analyte bring relevant insights regarding potential diseases. In this study, we aimed at developing machine learning models for COVID-19 diagnosis through CBCs, unlocking the predictive power of non-linear relationships between multiple blood analytes. Methods We collected 809,254 CBCs and 1,088,385 RT-PCR tests for SARS-Cov-2, of which 21% (234,466) were positive, from 900,220 unique individuals. To properly screen COVID-19, we also collected 120,807 CBCs of 16,940 individuals who tested positive for other respiratory viruses. We proposed an ensemble procedure that combines machine learning models for different respiratory infections and analyzed the results in both the first and second waves of COVID-19 cases in Brazil. Results We obtain a high-performance AUROC of 90 + % for validations in both scenarios. We show that models built solely of SARS-Cov-2 data are biased, performing poorly in the presence of infections due to other RNA respiratory viruses. Conclusions We demonstrate the potential of a novel machine learning approach for COVID-19 diagnosis based on a CBC and show that aggregating information about other respiratory diseases was essential to guarantee robustness in the results. Given its versatile nature, low cost, and speed, we believe that our tool can be particularly useful in a variety of scenarios—both during the pandemic and after. The complete blood count (CBC) is a medical laboratory test that provides information about cells in a person’s blood and is extensively used to support medical decisions. This study explored the ability of a computer-based approach to automatically identify active COVID-19 infections by using CBC exams. We collected a large dataset with over one million CBC exams and the matching tests currently used to detect SARS-Cov-2 or other respiratory viruses. Our results demonstrate both the potential of this approach for diagnosing SARS-Cov-2 infection by using only CBC data, and also that considering information about other respiratory diseases in the methodology is essential to guarantee that results can be trusted. This automated computational approach can be useful in a variety of contexts during the COVID-19 pandemic and after since it is fast, low-cost, and versatile. Zuin et al. use a large dataset of blood count exams to predict SARS-CoV-2 PCR results with machine learning. The model performs well and is superior to those that do not take into account infection with other RNA respiratory viruses.
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Affiliation(s)
- Gianlucca Zuin
- Universidade Federal de Minas Gerais, CS Dept., Belo Horizonte, Brazil.,Kunumi, Belo Horizonte, Brazil
| | - Daniella Araujo
- Universidade Federal de Minas Gerais, CS Dept., Belo Horizonte, Brazil.,Huna, São Paulo, Brazil
| | | | | | | | | | | | | | - Adriano Veloso
- Universidade Federal de Minas Gerais, CS Dept., Belo Horizonte, Brazil
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Clinical and Laboratory Approach to Diagnose COVID-19 Using Machine Learning. Interdiscip Sci 2022; 14:452-470. [PMID: 35133633 PMCID: PMC8846962 DOI: 10.1007/s12539-021-00499-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/18/2022]
Abstract
Coronavirus 2 (SARS-CoV-2), often known by the name COVID-19, is a type of acute respiratory syndrome that has had a significant influence on both economy and health infrastructure worldwide. This novel virus is diagnosed utilising a conventional method known as the RT-PCR (Reverse Transcription Polymerase Chain Reaction) test. This approach, however, produces a lot of false-negative and erroneous outcomes. According to recent studies, COVID-19 can also be diagnosed using X-rays, CT scans, blood tests and cough sounds. In this article, we use blood tests and machine learning to predict the diagnosis of this deadly virus. We also present an extensive review of various existing machine-learning applications that diagnose COVID-19 from clinical and laboratory markers. Four different classifiers along with a technique called Synthetic Minority Oversampling Technique (SMOTE) were used for classification. Shapley Additive Explanations (SHAP) method was utilized to calculate the gravity of each feature and it was found that eosinophils, monocytes, leukocytes and platelets were the most critical blood parameters that distinguished COVID-19 infection for our dataset. These classifiers can be utilized in conjunction with RT-PCR tests to improve sensitivity and in emergency situations such as a pandemic outbreak that might happen due to new strains of the virus. The positive results indicate the prospective use of an automated framework that could help clinicians and medical personnel diagnose and screen patients.
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7
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Carobene A, Milella F, Famiglini L, Cabitza F. How is test laboratory data used and characterised by machine learning models? A systematic review of diagnostic and prognostic models developed for COVID-19 patients using only laboratory data. Clin Chem Lab Med 2022; 60:1887-1901. [PMID: 35508417 DOI: 10.1515/cclm-2022-0182] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 12/13/2022]
Abstract
The current gold standard for COVID-19 diagnosis, the rRT-PCR test, is hampered by long turnaround times, probable reagent shortages, high false-negative rates and high prices. As a result, machine learning (ML) methods have recently piqued interest, particularly when applied to digital imagery (X-rays and CT scans). In this review, the literature on ML-based diagnostic and prognostic studies grounded on hematochemical parameters has been considered. By doing so, a gap in the current literature was addressed concerning the application of machine learning to laboratory medicine. Sixty-eight articles have been included that were extracted from the Scopus and PubMed indexes. These studies were marked by a great deal of heterogeneity in terms of the examined laboratory test and clinical parameters, sample size, reference populations, ML algorithms, and validation approaches. The majority of research was found to be hampered by reporting and replicability issues: only four of the surveyed studies provided complete information on analytic procedures (units of measure, analyzing equipment), while 29 provided no information at all. Only 16 studies included independent external validation. In light of these findings, we discuss the importance of closer collaboration between data scientists and medical laboratory professionals in order to correctly characterise the relevant population, select the most appropriate statistical and analytical methods, ensure reproducibility, enable the proper interpretation of the results, and gain actual utility by using machine learning methods in clinical practice.
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Affiliation(s)
- Anna Carobene
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Federico Cabitza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,DISCo, Università Degli Studi di Milano-Bicocca, Milan, Italy
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8
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Colak A, Oncel D, Altın Z, Turken M, Arslan FD, Iyilikci V, Yilmaz N, Oncel G, Kose S. Usefulness of laboratory parameters and chest CT in the early diagnosis of COVID-19. Rev Inst Med Trop Sao Paulo 2022; 64:e28. [PMID: 35384959 PMCID: PMC8993152 DOI: 10.1590/s1678-9946202264028] [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: 10/30/2021] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
In the present study, the importance of laboratory parameters and CT findings in the early diagnosis of COVID-19 was investigated. To this end, 245 patients admitted between April 1st, and May 30th, 2020 with suspected COVID-19 were enrolled. The patients were divided into three groups according to chest CT findings and RT-PCR results. The non-COVID-19 group consisted of 71 patients with negative RT-PCR results and no chest CT findings. Ninety-five patients with positive RT-PCR results and negativechest CT findings were included in the COVID-19 group; 79 patients with positive RT-PCR results and chest CT findings consistent with COVID-19 manifestations were included in COVID-19 pneumonia group. Chest CT findings were positive in 45% of all COVID-19 patients. Patients with positive chest CT findings had mild (n=30), moderate (n=21) andor severe (n=28) lung involvement. In the COVID-19 group, CRP levels and the percentage of monocytes increased significantly. As disease progressed from mild to severe, CRP, LDH and ferritin levels gradually increased. In the ROC analysis, the area under the curve corresponding to the percentage value of monocytes (AUC=0.887) had a very good accuracy in predicting COVID-19 cases. The multinomial logistic regression analysis showed that CRP, LYM and % MONO were independent factors for COVID-19. Furthermore, the chest CT evaluation is a relevant tool in patients with clinical suspicion of COVID-19 pneumonia and negative RT-PCR results. In addition to decreased lymphocyte count, the increased percentage of monocytes may also guide the diagnosis.
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Affiliation(s)
- Ayfer Colak
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Dilek Oncel
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Radiology, Izmir, Turkey
| | - Zeynep Altın
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Internal Medicine, Izmir, Turkey
| | - Melda Turken
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Fatma Demet Arslan
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Veli Iyilikci
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Nisel Yilmaz
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Microbiology, Izmir, Turkey
| | - Guray Oncel
- Bakircay University, Cigli Training and Research Hospital, Department of Radiology, Izmir, Turkey
| | - Sukran Kose
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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9
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Rahman T, Khandakar A, Abir FF, Faisal MAA, Hossain MS, Podder KK, Abbas TO, Alam MF, Kashem SB, Islam MT, Zughaier SM, Chowdhury MEH. QCovSML: A reliable COVID-19 detection system using CBC biomarkers by a stacking machine learning model. Comput Biol Med 2022; 143:105284. [PMID: 35180500 PMCID: PMC8839805 DOI: 10.1016/j.compbiomed.2022.105284] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 12/31/2022]
Abstract
The reverse transcription-polymerase chain reaction (RT-PCR) test is considered the current gold standard for the detection of coronavirus disease (COVID-19), although it suffers from some shortcomings, namely comparatively longer turnaround time, higher false-negative rates around 20-25%, and higher cost equipment. Therefore, finding an efficient, robust, accurate, and widely available, and accessible alternative to RT-PCR for COVID-19 diagnosis is a matter of utmost importance. This study proposes a complete blood count (CBC) biomarkers-based COVID-19 detection system using a stacking machine learning (SML) model, which could be a fast and less expensive alternative. This study used seven different publicly available datasets, where the largest one consisting of fifteen CBC biomarkers collected from 1624 patients (52% COVID-19 positive) admitted at San Raphael Hospital, Italy from February to May 2020 was used to train and validate the proposed model. White blood cell count, monocytes (%), lymphocyte (%), and age parameters collected from the patients during hospital admission were found to be important biomarkers for COVID-19 disease prediction using five different feature selection techniques. Our stacking model produced the best performance with weighted precision, sensitivity, specificity, overall accuracy, and F1-score of 91.44%, 91.44%, 91.44%, 91.45%, and 91.45%, respectively. The stacking machine learning model improved the performance in comparison to other state-of-the-art machine learning classifiers. Finally, a nomogram-based scoring system (QCovSML) was constructed using this stacking approach to predict the COVID-19 patients. The cut-off value of the QCovSML system for classifying COVID-19 and Non-COVID patients was 4.8. Six datasets from three different countries were used to externally validate the proposed model to evaluate its generalizability and robustness. The nomogram demonstrated good calibration and discrimination with the area under the curve (AUC) of 0.961 for the internal cohort and average AUC of 0.967 for all external validation cohort, respectively. The external validation shows an average weighted precision, sensitivity, F1-score, specificity, and overall accuracy of 92.02%, 95.59%, 93.73%, 90.54%, and 93.34%, respectively.
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Affiliation(s)
- Tawsifur Rahman
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Farhan Fuad Abir
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Ahasan Atick Faisal
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Shafayet Hossain
- Dept. of Electrical, Electronics and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Selangor, 43600, Malaysia
| | - Kanchon Kanti Podder
- Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Tariq O Abbas
- Urology Division, Surgery Department, Sidra Medicine, Doha, 26999, Qatar
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
| | - Saad Bin Kashem
- Department of Computing Science, AFG College with the University of Aberdeen, Doha, Qatar
| | - Mohammad Tariqul Islam
- Dept. of Electrical, Electronics and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Selangor, 43600, Malaysia
| | - Susu M Zughaier
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, 2713, Qatar
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10
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Roland T, Böck C, Tschoellitsch T, Maletzky A, Hochreiter S, Meier J, Klambauer G. Domain Shifts in Machine Learning Based Covid-19 Diagnosis From Blood Tests. J Med Syst 2022. [PMID: 35348909 DOI: 10.1101/2021.04.06.21254997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Many previous studies claim to have developed machine learning models that diagnose COVID-19 from blood tests. However, we hypothesize that changes in the underlying distribution of the data, so called domain shifts, affect the predictive performance and reliability and are a reason for the failure of such machine learning models in clinical application. Domain shifts can be caused, e.g., by changes in the disease prevalence (spreading or tested population), by refined RT-PCR testing procedures (way of taking samples, laboratory procedures), or by virus mutations. Therefore, machine learning models for diagnosing COVID-19 or other diseases may not be reliable and degrade in performance over time. We investigate whether domain shifts are present in COVID-19 datasets and how they affect machine learning methods. We further set out to estimate the mortality risk based on routinely acquired blood tests in a hospital setting throughout pandemics and under domain shifts. We reveal domain shifts by evaluating the models on a large-scale dataset with different assessment strategies, such as temporal validation. We present the novel finding that domain shifts strongly affect machine learning models for COVID-19 diagnosis and deteriorate their predictive performance and credibility. Therefore, frequent re-training and re-assessment are indispensable for robust models enabling clinical utility.
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Affiliation(s)
- Theresa Roland
- ELLIS Unit Linz, LIT AI Lab, Institute for Machine Learning, Johannes Kepler University Linz, Linz, Austria.
| | - Carl Böck
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | | | - Sepp Hochreiter
- ELLIS Unit Linz, LIT AI Lab, Institute for Machine Learning, Johannes Kepler University Linz, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Günter Klambauer
- ELLIS Unit Linz, LIT AI Lab, Institute for Machine Learning, Johannes Kepler University Linz, Linz, Austria
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11
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Roland T, Böck C, Tschoellitsch T, Maletzky A, Hochreiter S, Meier J, Klambauer G. Domain Shifts in Machine Learning Based Covid-19 Diagnosis From Blood Tests. J Med Syst 2022; 46:23. [PMID: 35348909 PMCID: PMC8960704 DOI: 10.1007/s10916-022-01807-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/10/2022] [Indexed: 12/23/2022]
Abstract
AbstractMany previous studies claim to have developed machine learning models that diagnose COVID-19 from blood tests. However, we hypothesize that changes in the underlying distribution of the data, so called domain shifts, affect the predictive performance and reliability and are a reason for the failure of such machine learning models in clinical application. Domain shifts can be caused, e.g., by changes in the disease prevalence (spreading or tested population), by refined RT-PCR testing procedures (way of taking samples, laboratory procedures), or by virus mutations. Therefore, machine learning models for diagnosing COVID-19 or other diseases may not be reliable and degrade in performance over time. We investigate whether domain shifts are present in COVID-19 datasets and how they affect machine learning methods. We further set out to estimate the mortality risk based on routinely acquired blood tests in a hospital setting throughout pandemics and under domain shifts. We reveal domain shifts by evaluating the models on a large-scale dataset with different assessment strategies, such as temporal validation. We present the novel finding that domain shifts strongly affect machine learning models for COVID-19 diagnosis and deteriorate their predictive performance and credibility. Therefore, frequent re-training and re-assessment are indispensable for robust models enabling clinical utility.
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Affiliation(s)
- Theresa Roland
- ELLIS Unit Linz, LIT AI Lab, Institute for Machine Learning, Johannes Kepler University Linz, Linz, Austria.
| | - Carl Böck
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | | | - Sepp Hochreiter
- ELLIS Unit Linz, LIT AI Lab, Institute for Machine Learning, Johannes Kepler University Linz, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Günter Klambauer
- ELLIS Unit Linz, LIT AI Lab, Institute for Machine Learning, Johannes Kepler University Linz, Linz, Austria
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12
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Adir Y, Saliba W, Beurnier A, Humbert M. Asthma and COVID-19: an update. Eur Respir Rev 2021; 30:30/162/210152. [PMID: 34911694 PMCID: PMC8674937 DOI: 10.1183/16000617.0152-2021] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
As the world faces the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, concerns have been raised that asthma patients could be at increased risk of SARS-CoV-2 infection and disease severity. However, it appears that asthma is not an independent risk factor for both. Furthermore, asthma is not over-represented in hospitalised patients with severe pneumonia due to SARS-CoV-2 infection and there was no increased risk of asthma exacerbations triggered by SARS-CoV-2. There is accumulating evidence that asthma phenotypes and comorbidities are important factors in evaluating the risk for SARS-CoV-2 infection and disease severity, as findings suggest that Th2-high inflammation may reduce the risk of SARS-Cov-2 infection and disease severity in contrast to increased risk in patients with Th2-low asthma. The use of inhaled corticosteroids (ICS) is safe in asthma patients with SARS-CoV-2 infection. Furthermore, it has been proposed that ICS may confer some degree of protection against SARS-CoV-2 infection and the development of severe disease by reducing the expression of angiotensin converting enzyme-2 and transmembrane protease serine in the lung. In contrast, chronic or recurrent use of systemic corticosteroids before SARS-CoV-2 infection is a major risk factor of poor outcomes and worst survival in asthma patients. Conversely, biological therapy for severe allergic and eosinophilic asthma does not increase the risk of being infected with SARS-CoV-2 or having worse COVID-19 severity. In the present review we will summarise the current literature regarding asthma and COVID-19. Chronic or recurrent use of systemic corticosteroids before SARS-CoV-2 infection is a major risk factor of worst COVID-19 severity and survival in asthmatics as opposed to ICS and biological therapy which seems to be safe.https://bit.ly/3jU0zLR
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Affiliation(s)
- Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine Technion Institute of Technology, Haifa, Israel .,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Dept of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Antoine Beurnier
- Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Dept of Respiratory and Intensive Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,INSERM, UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marc Humbert
- Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Dept of Respiratory and Intensive Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,INSERM, UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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13
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McRae AD, Hohl CM, Rosychuk R, Vatanpour S, Ghaderi G, Archambault PM, Brooks SC, Cheng I, Davis P, Hayward J, Lang E, Ohle R, Rowe B, Welsford M, Yadav K, Morrison LJ, Perry J. CCEDRRN COVID-19 Infection Score (CCIS): development and validation in a Canadian cohort of a clinical risk score to predict SARS-CoV-2 infection in patients presenting to the emergency department with suspected COVID-19. BMJ Open 2021; 11:e055832. [PMID: 34857584 PMCID: PMC8640195 DOI: 10.1136/bmjopen-2021-055832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To develop and validate a clinical risk score that can accurately quantify the probability of SARS-CoV-2 infection in patients presenting to an emergency department without the need for laboratory testing. DESIGN Cohort study of participants in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. Regression models were fitted to predict a positive SARS-CoV-2 test result using clinical and demographic predictors, as well as an indicator of local SARS-CoV-2 incidence. SETTING 32 emergency departments in eight Canadian provinces. PARTICIPANTS 27 665 consecutively enrolled patients who were tested for SARS-CoV-2 in participating emergency departments between 1 March and 30 October 2020. MAIN OUTCOME MEASURES Positive SARS-CoV-2 nucleic acid test result within 14 days of an index emergency department encounter for suspected COVID-19 disease. RESULTS We derived a 10-item CCEDRRN COVID-19 Infection Score using data from 21 743 patients. This score included variables from history and physical examination and an indicator of local disease incidence. The score had a c-statistic of 0.838 with excellent calibration. We externally validated the rule in 5295 patients. The score maintained excellent discrimination and calibration and had superior performance compared with another previously published risk score. Score cut-offs were identified that can rule-in or rule-out SARS-CoV-2 infection without the need for nucleic acid testing with 97.4% sensitivity (95% CI 96.4 to 98.3) and 95.9% specificity (95% CI 95.5 to 96.0). CONCLUSIONS The CCEDRRN COVID-19 Infection Score uses clinical characteristics and publicly available indicators of disease incidence to quantify a patient's probability of SARS-CoV-2 infection. The score can identify patients at sufficiently high risk of SARS-CoV-2 infection to warrant isolation and empirical therapy prior to test confirmation while also identifying patients at sufficiently low risk of infection that they may not need testing. TRIAL REGISTRATION NUMBER NCT04702945.
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Affiliation(s)
- Andrew D McRae
- Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Rhonda Rosychuk
- Department of Paediatrics, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Shabnam Vatanpour
- Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gelareh Ghaderi
- Department of Emergency Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Patrick M Archambault
- Department of Emergency Medicine, Universite Laval Faculte de medecine, Quebec, Quebec, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Ivy Cheng
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Robert Ohle
- Department of Emergency Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Brian Rowe
- Department of Emergency Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Michelle Welsford
- Department of Emergency Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Laurie J Morrison
- Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
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14
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Baktash V, Hosack T, Rule R, Patel N, Kho J, Sekhar R, Mandal AKJ, Missouris CG. Development, evaluation and validation of machine learning algorithms to detect atypical and asymptomatic presentations of Covid-19 in hospital practice. QJM 2021; 114:496-501. [PMID: 34156436 DOI: 10.1093/qjmed/hcab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diagnostic methods for Covid-19 have improved, both in speed and availability. Because of atypical and asymptomatic carriage of the virus and nosocomial spread within institutions, timely diagnosis remains a challenge. Machine learning models trained on blood test results have shown promise in identifying cases of Covid-19. AIMS To train and validate a machine learning model capable of differentiating Covid-19 positive from negative patients using routine blood tests and assess the model's accuracy against atypical and asymptomatic presentations. DESIGN AND METHODS We conducted a retrospective analysis of medical admissions to our institution during March and April 2020. Participants were categorized into Covid-19 positive or negative groups based on clinical, radiological features or nasopharyngeal swab. A machine learning model was trained on laboratory parameters and validated for accuracy, sensitivity and specificity and externally validated at an unconnected establishment. RESULTS An Ensemble Bagged Tree model was trained on data collected from 405 patients (212 Covid-19 positive) producing an accuracy of 81.79% (95% confidence interval (CI) 77.53-85.55%), the sensitivity of 85.85% (CI 80.42-90.24%) and specificity of 76.65% (CI 69.49-82.84%). Accuracy was preserved for atypical and asymptomatic subgroups. Using an external data set for 226 patients (141 Covid-19 positive) accuracy of 76.82% (CI 70.87-82.08%), sensitivity of 78.38% (CI 70.87-84.72%) and specificity of 74.12% (CI 63.48-83.01%) was achieved. CONCLUSION A machine learning model using routine laboratory parameters can detect atypical and asymptomatic presentations of Covid-19 and might be an adjunct to existing screening measures.
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Affiliation(s)
- V Baktash
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - T Hosack
- Department of Medicine, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, Buckinghamshire, HP21 8AL, UK
| | - R Rule
- Department of Medicine, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, Buckinghamshire, HP21 8AL, UK
| | - N Patel
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - J Kho
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - R Sekhar
- Department of Medicine, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, Buckinghamshire, HP21 8AL, UK
| | - A K J Mandal
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - C G Missouris
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
- Department of Clinical Cardiology, University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi 2408 Nicosia, Cyprus
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15
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Nguyen S, Chan R, Cadena J, Soper B, Kiszka P, Womack L, Work M, Duggan JM, Haller ST, Hanrahan JA, Kennedy DJ, Mukundan D, Ray P. Budget constrained machine learning for early prediction of adverse outcomes for COVID-19 patients. Sci Rep 2021; 11:19543. [PMID: 34599200 PMCID: PMC8486861 DOI: 10.1038/s41598-021-98071-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/25/2021] [Indexed: 02/08/2023] Open
Abstract
The combination of machine learning (ML) and electronic health records (EHR) data may be able to improve outcomes of hospitalized COVID-19 patients through improved risk stratification and patient outcome prediction. However, in resource constrained environments the clinical utility of such data-driven predictive tools may be limited by the cost or unavailability of certain laboratory tests. We leveraged EHR data to develop an ML-based tool for predicting adverse outcomes that optimizes clinical utility under a given cost structure. We further gained insights into the decision-making process of the ML models through an explainable AI tool. This cohort study was performed using deidentified EHR data from COVID-19 patients from ProMedica Health System in northwest Ohio and southeastern Michigan. We tested the performance of various ML approaches for predicting either increasing ventilatory support or mortality. We performed post hoc analysis to obtain optimal feature sets under various budget constraints. We demonstrate that it is possible to achieve a significant reduction in cost at the expense of a small reduction in predictive performance. For example, when predicting ventilation, it is possible to achieve a 43% reduction in cost with only a 3% reduction in performance. Similarly, when predicting mortality, it is possible to achieve a 50% reduction in cost with only a 1% reduction in performance. This study presents a quick, accurate, and cost-effective method to evaluate risk of deterioration for patients with SARS-CoV-2 infection at the time of clinical evaluation.
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Affiliation(s)
- Sam Nguyen
- grid.250008.f0000 0001 2160 9702Lawrence Livermore National Laboratory, 7000 East Ave, Livermore, CA 94550 USA
| | - Ryan Chan
- grid.250008.f0000 0001 2160 9702Lawrence Livermore National Laboratory, 7000 East Ave, Livermore, CA 94550 USA
| | - Jose Cadena
- grid.250008.f0000 0001 2160 9702Lawrence Livermore National Laboratory, 7000 East Ave, Livermore, CA 94550 USA
| | - Braden Soper
- grid.250008.f0000 0001 2160 9702Lawrence Livermore National Laboratory, 7000 East Ave, Livermore, CA 94550 USA
| | - Paul Kiszka
- ProMedica Health System, Inc, 3103 Executive Pkwy, Toledo, OH 43606 USA
| | - Lucas Womack
- ProMedica Health System, Inc, 3103 Executive Pkwy, Toledo, OH 43606 USA
| | - Mark Work
- ProMedica Health System, Inc, 3103 Executive Pkwy, Toledo, OH 43606 USA
| | - Joan M. Duggan
- grid.267337.40000 0001 2184 944XDepartment of Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 USA
| | - Steven T. Haller
- grid.267337.40000 0001 2184 944XDepartment of Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 USA
| | - Jennifer A. Hanrahan
- grid.267337.40000 0001 2184 944XDepartment of Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 USA
| | - David J. Kennedy
- grid.267337.40000 0001 2184 944XDepartment of Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 USA
| | - Deepa Mukundan
- grid.267337.40000 0001 2184 944XDepartment of Pediatrics, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 USA
| | - Priyadip Ray
- grid.250008.f0000 0001 2160 9702Lawrence Livermore National Laboratory, 7000 East Ave, Livermore, CA 94550 USA
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16
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Zhang RK, Xiao Q, Zhu SL, Lin HY, Tang M. Using different machine learning models to classify patients into mild and severe cases of COVID-19 based on multivariate blood testing. J Med Virol 2021; 94:357-365. [PMID: 34542195 PMCID: PMC8661590 DOI: 10.1002/jmv.27352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 is a serious respiratory disease. The ever-increasing number of cases is causing heavier loads on the health service system. Using 38 blood test indicators on the first day of admission for the 422 patients diagnosed with COVID-19 (from January 2020 to June 2021) to construct different machine learning (ML) models to classify patients into either mild or severe cases of COVID-19. All models show good performance in the classification between COVID-19 patients into mild and severe disease. The area under the curve (AUC) of the random forest model is 0.89, the AUC of the naive Bayes model is 0.90, the AUC of the support vector machine model is 0.86, and the AUC of the KNN model is 0.78, the AUC of the Logistic regression model is 0.84, and the AUC of the artificial neural network model is 0.87, among which the naive Bayes model has the best performance. Different ML models can classify patients into mild and severe cases based on 38 blood test indicators taken on the first day of admission for patients diagnosed with COVID-19.
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Affiliation(s)
- Rui-Kun Zhang
- Health Science Center, Shenzhen University, Shenzhen, China
| | - Qi Xiao
- Health Science Center, Shenzhen University, Shenzhen, China
| | - Sheng-Lang Zhu
- Department of nephrology, Shenzhen Nanshan People's Hospital and The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hai-Yan Lin
- Department of nephrology, Shenzhen Nanshan People's Hospital and The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Ming Tang
- Department of Critical Care Medicine, Shenzhen Third People's Hospital, The Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
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17
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Małecka-Giełdowska M, Fołta M, Wiśniewska A, Czyżewska E, Ciepiela O. Cell Population Data and Serum Polyclonal Immunoglobulin Free Light Chains in the Assessment of COVID-19 Severity. Viruses 2021; 13:v13071381. [PMID: 34372587 PMCID: PMC8310347 DOI: 10.3390/v13071381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 12/26/2022] Open
Abstract
Distinguishing between severe and nonsevere COVID-19 to ensure adequate healthcare quality and efficiency is a challenge for the healthcare system. The aim of this study was to assess the usefulness of CBC parameters together with analysis of FLC serum concentration in risk stratification of COVID-19. Materials and methods: CBC was analyzed in 735 COVID ICU, COVID non-ICU, and non-COVID ICU cases. FLC concentration was analyzed in 133 of them. Results: COVID ICU had neutrophils and lymphocytes with the greatest size, granularity, and nucleic acid content. Significant differences in concentrations of κ and λ FLCs were shown between COVID ICU and COVID non-ICU. However, no difference was found in the κ/λ ratio between these groups, and the ratio stayed within the reference value, which indicates the presence of polyclonal FLCs. FLC κ measurement has significant power to distinguish between severe COVID-19 and nonsevere COVID-19 (AUC = 0.7669), with a sensitivity of 86.67% and specificity of 93.33%. The κ coefficients’ odds ratio of 3.0401 was estimated. Conclusion: It can be concluded that the results obtained from the measure of free light immunoglobulin concentration in serum are useful in distinguishing between severe and nonsevere COVID-19.
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Affiliation(s)
- Milena Małecka-Giełdowska
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-599-2105
| | - Maria Fołta
- Students Scientific Group of Laboratory Medicine, Department of Laboratory Medicine, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Agnieszka Wiśniewska
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Emilia Czyżewska
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Olga Ciepiela
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
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Huang R, Xie L, He J, Dong H, Liu T. Association between the peripheral blood eosinophil counts and COVID-19: A meta-analysis. Medicine (Baltimore) 2021; 100:e26047. [PMID: 34114990 PMCID: PMC8202592 DOI: 10.1097/md.0000000000026047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The conclusions about the relationship between eosinophil counts and the severity of coronavirus disease 2019 (COVID-19) were controversial, so we updated the evidences and reassessed it. METHODS We searched the PubMed, Cochrane library, Excerpta Medica Database, and Web of Science to compare the eosinophil counts about non-severe disease group (mild pneumonia, moderate pneumonia, non-critical disease and recovery group) and severe disease group (severe pneumonia, critical pneumonia, critical disease and death group) in COVID-19. RESULTS A total of 1228 patients from 10 studies were included. Compared with non-severe group, severe group had strikingly lower average eosinophil counts (SMD 0.65, 95% confidence intervals [CI] 0.29-1.01; P < .001). The result of subgroup analysis of different countries showed SMD 0.66, 95% CI 0.26-1.06; P < .001. Another subgroup analysis between mild-moderate pneumonia versus severe-critical pneumonia showed SMD 0.69, 95% CI 0.25-1.13; P < .001, and no significant risk of publication bias (Begg test 0.063 and Egger test 0.057) in this subgroup. The heterogeneity was substantial, but the sensitivity analyses showed no significant change when individual study was excluded, which suggested the crediblity and stablity of our results. CONCLUSIONS The eosinophil counts had important value as an indicator of severity in patients with COVID-19. PROSPERO REGISTRATION NUMBER CRD42020205497.
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19
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Relevance aggregation for neural networks interpretability and knowledge discovery on tabular data. Inf Sci (N Y) 2021. [DOI: 10.1016/j.ins.2021.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Li J, Li S, Qiu X, Zhu W, Li L, Qin B. Performance of Diagnostic Model for Differentiating Between COVID-19 and Influenza: A 2-Center Retrospective Study. Med Sci Monit 2021; 27:e932361. [PMID: 33976103 PMCID: PMC8127639 DOI: 10.12659/msm.932361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 and influenza share many similarities, such as mode of transmission and clinical symptoms. Failure to distinguish the 2 diseases may increase the risk of transmission. A fast and convenient differential diagnosis between COVID-19 and influenza has significant clinical value, especially for low- and middle-income countries with a shortage of nucleic acid detection kits. We aimed to establish a diagnostic model to differentiate COVID-19 and influenza based on clinical data. Material/Methods A total of 493 patients were enrolled in the study, including 282 with COVID-19 and 211 with influenza. All data were collected and reviewed retrospectively. The clinical and laboratory characteristics of all patients were analyzed and compared. We then randomly divided all patients into development sets and validation sets to establish a diagnostic model using multivariate logistic regression analysis. Finally, we validated the diagnostic model using the validation set. Results We preliminarily established a diagnostic model for differentiating COVID-19 from influenza that consisted of 5 variables: age, dry cough, fever, white cell count, and D-dimer. The model showed good performance for differential diagnosis. Conclusions This initial model including clinical features and laboratory indices effectively differentiated COVID-19 from influenza. Patients with a high score were at a high risk of having COVID-19, while patients with a low score were at a high risk of having influenza. This model could help clinicians quickly identify and isolate cases in the absence of nucleic acid tests, especially during the cocirculation of COVID-19 and influenza. Owing to the study’s retrospective nature, further prospective study is needed to validate the accuracy of the model.
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Affiliation(s)
- Jingwen Li
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Simin Li
- Data Processing Department, Yidu Cloud Technology Inc., Beijing, China (mainland)
| | - Xiaoming Qiu
- Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei, China (mainland)
| | - Wenyan Zhu
- Data Processing Department, Yidu Cloud Technology Inc., Beijing, China (mainland)
| | - Linfeng Li
- Data Processing Department, Yidu Cloud Technology Inc., Beijing, China (mainland)
| | - Bo Qin
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chhongqing, China (mainland)
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21
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Do Blood Eosinophils Predict in-Hospital Mortality or Severity of Disease in SARS-CoV-2 Infection? A Retrospective Multicenter Study. Microorganisms 2021; 9:microorganisms9020334. [PMID: 33567583 PMCID: PMC7914916 DOI: 10.3390/microorganisms9020334] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Healthcare systems worldwide have been battling the ongoing COVID-19 pandemic. Eosinophils are multifunctional leukocytes implicated in the pathogenesis of several inflammatory processes including viral infections. We focus our study on the prognostic value of eosinopenia as a marker of disease severity and mortality in COVID-19 patients. Methods: Between 1 March and 30 April 2020, we conducted a multicenter and retrospective study on a cohort of COVID-19 patients (moderate or severe disease) who were hospitalized after presenting to the emergency department (ED). We led our study in six major hospitals of northeast France, one of the outbreak’s epicenters in Europe. Results: We have collected data from 1035 patients, with a confirmed diagnosis of COVID-19. More than three quarters of them (76.2%) presented a moderate form of the disease, while the remaining quarter (23.8%) presented a severe form requiring admission to the intensive care unit (ICU). Mean circulating eosinophils rate, at admission, varied according to disease severity (p < 0.001), yet it did not differ between survivors and non-survivors (p = 0.306). Extreme eosinopenia (=0/mm3) was predictive of severity (aOR = 1.77, p = 0.009); however, it was not predictive of mortality (aOR = 0.892, p = 0.696). The areas under the Receiver operating characteristics (ROC) curve were, respectively, 58.5% (CI95%: 55.3–61.7%) and 51.4% (CI95%: 46.8–56.1%) for the ability of circulating eosinophil rates to predict disease severity and mortality. Conclusion: Eosinopenia is very common and often profound in cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Eosinopenia was not a useful predictor of mortality; however, undetectable eosinophils (=0/mm3) were predictive of disease severity during the initial ED management.
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22
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Jimenez-Solem E, Petersen TS, Hansen C, Hansen C, Lioma C, Igel C, Boomsma W, Krause O, Lorenzen S, Selvan R, Petersen J, Nyeland ME, Ankarfeldt MZ, Virenfeldt GM, Winther-Jensen M, Linneberg A, Ghazi MM, Detlefsen N, Lauritzen AD, Smith AG, de Bruijne M, Ibragimov B, Petersen J, Lillholm M, Middleton J, Mogensen SH, Thorsen-Meyer HC, Perner A, Helleberg M, Kaas-Hansen BS, Bonde M, Bonde A, Pai A, Nielsen M, Sillesen M. Developing and validating COVID-19 adverse outcome risk prediction models from a bi-national European cohort of 5594 patients. Sci Rep 2021; 11:3246. [PMID: 33547335 PMCID: PMC7864944 DOI: 10.1038/s41598-021-81844-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with severe COVID-19 have overwhelmed healthcare systems worldwide. We hypothesized that machine learning (ML) models could be used to predict risks at different stages of management and thereby provide insights into drivers and prognostic markers of disease progression and death. From a cohort of approx. 2.6 million citizens in Denmark, SARS-CoV-2 PCR tests were performed on subjects suspected for COVID-19 disease; 3944 cases had at least one positive test and were subjected to further analysis. SARS-CoV-2 positive cases from the United Kingdom Biobank was used for external validation. The ML models predicted the risk of death (Receiver Operation Characteristics—Area Under the Curve, ROC-AUC) of 0.906 at diagnosis, 0.818, at hospital admission and 0.721 at Intensive Care Unit (ICU) admission. Similar metrics were achieved for predicted risks of hospital and ICU admission and use of mechanical ventilation. Common risk factors, included age, body mass index and hypertension, although the top risk features shifted towards markers of shock and organ dysfunction in ICU patients. The external validation indicated fair predictive performance for mortality prediction, but suboptimal performance for predicting ICU admission. ML may be used to identify drivers of progression to more severe disease and for prognostication patients in patients with COVID-19. We provide access to an online risk calculator based on these findings.
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Affiliation(s)
- Espen Jimenez-Solem
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tonny S Petersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Casper Hansen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hansen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Christina Lioma
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Igel
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Wouter Boomsma
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Oswin Krause
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Lorenzen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Raghavendra Selvan
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Martin Erik Nyeland
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Zöllner Ankarfeldt
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Gert Mehl Virenfeldt
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Nicki Detlefsen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark.,DTU Compute, Denmarks Technical University, Lyngby, Denmark
| | | | | | - Marleen de Bruijne
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bulat Ibragimov
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Jens Petersen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lillholm
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Jon Middleton
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Anders Perner
- Department of Intensive Care Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Mikkel Bonde
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alexander Bonde
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Akshay Pai
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark.,Cerebriu A/S, Copenhagen, Denmark
| | - Mads Nielsen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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23
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Eosinophils and COVID-19: diagnosis, prognosis, and vaccination strategies. Semin Immunopathol 2021; 43:383-392. [PMID: 33728484 PMCID: PMC7962927 DOI: 10.1007/s00281-021-00850-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
The unprecedented impact of the coronavirus disease 2019 (COVID-19) pandemic has resulted in global challenges to our health-care systems and our economic security. As such, there has been significant research into all aspects of the disease, including diagnostic biomarkers, associated risk factors, and strategies that might be used for its treatment and prevention. Toward this end, eosinopenia has been identified as one of many factors that might facilitate the diagnosis and prognosis of severe COVID-19. However, this finding is neither definitive nor pathognomonic for COVID-19. While eosinophil-associated conditions have been misdiagnosed as COVID-19 and others are among its reported complications, patients with pre-existing eosinophil-associated disorders (e.g., asthma, eosinophilic gastrointestinal disorders) do not appear to be at increased risk for severe disease; interestingly, several recent studies suggest that a diagnosis of asthma may be associated with some degree of protection. Finally, although vaccine-associated aberrant inflammatory responses, including eosinophil accumulation in the respiratory tract, were observed in preclinical immunization studies targeting the related SARS-CoV and MERS-CoV pathogens, no similar complications have been reported clinically in response to the widespread dissemination of either of the two encapsulated mRNA-based vaccines for COVID-19.
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24
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Noce A, Santoro ML, Marrone G, D'Agostini C, Amelio I, Duggento A, Tesauro M, Di Daniele N. Serological determinants of COVID-19. Biol Direct 2020; 15:21. [PMID: 33138856 PMCID: PMC7605129 DOI: 10.1186/s13062-020-00276-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreaded rapidly worldwide, as far as it has become a global pandemic. Therefore, the introduction of serological tests for determination of IgM and IgG antibodies has become the main diagnostic tool, useful for tracking the spread of the virus and for consequently allowing its containment. In our study we compared point of care test (POCT) lateral flow immunoassay (FIA) vs automated chemiluminescent immunoassay (CLIA), in order to assess their specificity and sensibility for COVID-19 antibodies detection. RESULTS We find that different specificities and sensitivities for IgM and IgG tests. Notably IgM POCT FIA method vs CLIA method (gold standard) has a low sensitivity (0.526), while IgG POCT FIA method vs CLIA method (gold standard) test has a much higher sensitivity (0.937); further, with respect of IgG, FIA and CLIA could arguably provide equivalent information. CONCLUSIONS FIA method could be helpful in assessing in short time, the possible contagiousness of subjects that for work reasons cannot guarantee "social distancing".
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Affiliation(s)
- Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Maria Luisa Santoro
- Laboratory Pathologist Director of Artemisia Lab - Alessandria, Via Piave, 76 00187, Rome, Italy
| | - Giulia Marrone
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - Cartesio D'Agostini
- Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
- Laboratory of Clinical Microbiology, Policlinico Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - Ivano Amelio
- Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Andrea Duggento
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - Manfredi Tesauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Nicola Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
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25
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Cabitza F, Campagner A, Ferrari D, Di Resta C, Ceriotti D, Sabetta E, Colombini A, De Vecchi E, Banfi G, Locatelli M, Carobene A. Development, evaluation, and validation of machine learning models for COVID-19 detection based on routine blood tests. Clin Chem Lab Med 2020; 59:421-431. [PMID: 33079698 DOI: 10.1515/cclm-2020-1294] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
Objectives The rRT-PCR test, the current gold standard for the detection of coronavirus disease (COVID-19), presents with known shortcomings, such as long turnaround time, potential shortage of reagents, false-negative rates around 15-20%, and expensive equipment. The hematochemical values of routine blood exams could represent a faster and less expensive alternative. Methods Three different training data set of hematochemical values from 1,624 patients (52% COVID-19 positive), admitted at San Raphael Hospital (OSR) from February to May 2020, were used for developing machine learning (ML) models: the complete OSR dataset (72 features: complete blood count (CBC), biochemical, coagulation, hemogasanalysis and CO-Oxymetry values, age, sex and specific symptoms at triage) and two sub-datasets (COVID-specific and CBC dataset, 32 and 21 features respectively). 58 cases (50% COVID-19 positive) from another hospital, and 54 negative patients collected in 2018 at OSR, were used for internal-external and external validation. Results We developed five ML models: for the complete OSR dataset, the area under the receiver operating characteristic curve (AUC) for the algorithms ranged from 0.83 to 0.90; for the COVID-specific dataset from 0.83 to 0.87; and for the CBC dataset from 0.74 to 0.86. The validations also achieved good results: respectively, AUC from 0.75 to 0.78; and specificity from 0.92 to 0.96. Conclusions ML can be applied to blood tests as both an adjunct and alternative method to rRT-PCR for the fast and cost-effective identification of COVID-19-positive patients. This is especially useful in developing countries, or in countries facing an increase in contagions.
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Affiliation(s)
| | - Andrea Campagner
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | | | - Chiara Di Resta
- Vita-Salute San Raffaele University; Unit of Genomics for Human Disease Diagnosis, Division of Genetics and Cell Biology, Milan, Italy
| | - Daniele Ceriotti
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Sabetta
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Colombini
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Elena De Vecchi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Carobene
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
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26
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Jolobe O. A Bayesian strategy for the asymptomatic healthcare worker. Clin Med (Lond) 2020; 20:e139-e140. [PMID: 32934061 DOI: 10.7861/clinmed.let.20.5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Jehi L, Ji X, Milinovich A, Erzurum S, Merlino A, Gordon S, Young JB, Kattan MW. Development and validation of a model for individualized prediction of hospitalization risk in 4,536 patients with COVID-19. PLoS One 2020; 15:e0237419. [PMID: 32780765 PMCID: PMC7418996 DOI: 10.1371/journal.pone.0237419] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 is a pandemic that is straining healthcare resources, mainly hospital beds. Multiple risk factors of disease progression requiring hospitalization have been identified, but medical decision-making remains complex. OBJECTIVE To characterize a large cohort of patients hospitalized with COVID-19, their outcomes, develop and validate a statistical model that allows individualized prediction of future hospitalization risk for a patient newly diagnosed with COVID-19. DESIGN Retrospective cohort study of patients with COVID-19 applying a least absolute shrinkage and selection operator (LASSO) logistic regression algorithm to retain the most predictive features for hospitalization risk, followed by validation in a temporally distinct patient cohort. The final model was displayed as a nomogram and programmed into an online risk calculator. SETTING One healthcare system in Ohio and Florida. PARTICIPANTS All patients infected with SARS-CoV-2 between March 8, 2020 and June 5, 2020. Those tested before May 1 were included in the development cohort, while those tested May 1 and later comprised the validation cohort. MEASUREMENTS Demographic, clinical, social influencers of health, exposure risk, medical co-morbidities, vaccination history, presenting symptoms, medications, and laboratory values were collected on all patients, and considered in our model development. RESULTS 4,536 patients tested positive for SARS-CoV-2 during the study period. Of those, 958 (21.1%) required hospitalization. By day 3 of hospitalization, 24% of patients were transferred to the intensive care unit, and around half of the remaining patients were discharged home. Ten patients died. Hospitalization risk was increased with older age, black race, male sex, former smoking history, diabetes, hypertension, chronic lung disease, poor socioeconomic status, shortness of breath, diarrhea, and certain medications (NSAIDs, immunosuppressive treatment). Hospitalization risk was reduced with prior flu vaccination. Model discrimination was excellent with an area under the curve of 0.900 (95% confidence interval of 0.886-0.914) in the development cohort, and 0.813 (0.786, 0.839) in the validation cohort. The scaled Brier score was 42.6% (95% CI 37.8%, 47.4%) in the development cohort and 25.6% (19.9%, 31.3%) in the validation cohort. Calibration was very good. The online risk calculator is freely available and found at https://riskcalc.org/COVID19Hospitalization/. LIMITATION Retrospective cohort design. CONCLUSION Our study crystallizes published risk factors of COVID-19 progression, but also provides new data on the role of social influencers of health, race, and influenza vaccination. In a context of a pandemic and limited healthcare resources, individualized outcome prediction through this nomogram or online risk calculator can facilitate complex medical decision-making.
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Affiliation(s)
- Lara Jehi
- Neurological Institute, Chief Research Information Officer, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Xinge Ji
- Quantitative Health Science Department, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Alex Milinovich
- Quantitative Health Science Department, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Serpil Erzurum
- Respiratory Institute, Chair of the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Amy Merlino
- Obstetrics and gynecology, Chief Medical Information Ofc., Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Steve Gordon
- Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - James B. Young
- Cardiology, Chief Academic Officer, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Michael W. Kattan
- Quantitative Health Science Department, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, United States of America
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