Machine learning identifies ICU outcome predictors in a multicenter COVID-19 cohort
Critical Care, vol. 25, pp. 295
Abstract
BACKGROUND: Intensive Care Resources are heavily utilized during the COVID-19 pandemic. However, risk stratification and prediction of SARS-CoV-2 patient clinical outcomes upon ICU admission remain inadequate. This study aimed to develop a machine learning model, based on retrospective & prospective clinical data, to stratify patient risk and predict ICU survival and outcomes. METHODS: A Germany-wide electronic registry was established to pseudonymously collect admission, therapeutic and discharge information of SARS-CoV-2 ICU patients retrospectively and prospectively. Machine learning approaches were evaluated for the accuracy and interpretability of predictions. The Explainable Boosting Machine approach was selected as the most suitable method. Individual, non-linear shape functions for predictive parameters and parameter interactions are reported. RESULTS: 1039 patients were included in the Explainable Boosting Machine model, 596 patients retrospectively collected, and 443 patients prospectively collected. The model for prediction of general ICU outcome was shown to be more reliable to predict "survival". Age, inflammatory and thrombotic activity, and severity of ARDS at ICU admission were shown to be predictive of ICU survival. Patients' age, pulmonary dysfunction and transfer from an external institution were predictors for ECMO therapy. The interaction of patient age with D-dimer levels on admission and creatinine levels with SOFA score without GCS were predictors for renal replacement therapy. CONCLUSIONS: Using Explainable Boosting Machine analysis, we confirmed and weighed previously reported and identified novel predictors for outcome in critically ill COVID-19 patients. Using this strategy, predictive modeling of COVID-19 ICU patient outcomes can be performed overcoming the limitations of linear regression models. Trial registration "ClinicalTrials" (clinicaltrials.gov) under NCT04455451.
Authors 47
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Harry Magunia corresponding
Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany. harry.magunia@med.uni-tuebingen.de
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
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Affiliation as printed
Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Affiliation as printed
Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Affiliation as printed
Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
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Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
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Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
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Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Affiliation as printed
Center for Anaesthesia, Intensive Care and Emergency Medicine, Zollernalb Klinikum, Balingen, Germany
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Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
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Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
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Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Berlin, Germany
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
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Universitätsklinikum Knappschaftskrankenhaus Bochum
Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine/Pain Therapy, Knappschaftskrankenhaus Bochum, Bochum, Germany
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University of Bonn · University Hospital Bonn
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Witten/Herdecke University · Evangelisches Krankenhaus Bethesda
Affiliation as printed
Chair of Anesthesiology 1, Witten/Herdecke University, Wuppertal, Germany
Department of Anesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Bethesda, Duisburg, Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Düsseldorf University Hospital
Affiliation as printed
Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
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Düsseldorf University Hospital
Affiliation as printed
Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
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Affiliation as printed
Center for Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
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Affiliation as printed
Department Cardiology, Angiology and Intensive Care Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
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Heidelberg University · University Hospital Heidelberg
Affiliation as printed
Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
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University Hospital Leipzig · Leipzig University
Affiliation as printed
Department of Anesthesiology and Intensive Care, Leipzig University Hospital, Leipzig, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Anaesthesiology and Intensive Care Therapy, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
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Philipps University of Marburg · Universitätsklinikum Gießen und Marburg
Affiliation as printed
University Hospital Marburg, UKGM, Philipps University Marburg, Marburg, Germany
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Justus-Liebig-Universität Gießen · Universitätsklinikum Gießen und Marburg
Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig University Giessen, Giessen, Germany
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TUM Klinikum · Technical University of Munich
Affiliation as printed
Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
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TUM Klinikum · Technical University of Munich
Affiliation as printed
Klinik Und Poliklinik Für Innere Medizin II, Klinikum Rechts Der Isar der, Technischen Universität München, Munich, Germany
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Affiliation as printed
Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
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Universitätsklinikum des Saarlandes · Saarland University
Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
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Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre, Witten/Herdecke University, Cologne-Merheim, Germany
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University of Würzburg · Universitätsklinikum Würzburg
Affiliation as printed
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University Wuerzburg, Wuerzburg, Germany
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University of Würzburg · Universitätsklinikum Würzburg
Affiliation as printed
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University Wuerzburg, Wuerzburg, Germany
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Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
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Affiliation as printed
Department of Computer Science, Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Affiliation as printed
Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Peter Rosenberger corresponding
Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany. peter.rosenberger@med.uni-tuebingen.de
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
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