Machine Learning Identifies ICU Outcome Predictors in a Multicenter COVID-19 Cohort.
Abstract
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. 1,039 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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University Hospital
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University Hospitals Tubingen: Universitatsklinikum Tubingen
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University Hospitals Tubingen: Universitatsklinikum Tubingen
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University Hospitals Tubingen: Universitatsklinikum Tubingen
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Affiliation as printed
University Hospitals Tubingen: Universitatsklinikum Tubingen
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Affiliation as printed
University Hospitals Tubingen: Universitatsklinikum Tubingen
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Affiliation as printed
University Hospitals Tubingen: Universitatsklinikum Tubingen
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Affiliation as printed
University Hospitals Tubingen: Universitatsklinikum Tubingen
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Gernot Marx Aachen
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Aachen University of Technology: Rheinisch-Westfalische Technische Hochschule Aachen
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Johannes Bickenbach Aachen
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Aachen University of Technology: Rheinisch-Westfalische Technische Hochschule Aachen
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Zollernalb Klinikum Balingen
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Charité - Universitätsmedizin Berlin
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Charite Universitatsmedizin Berlin Campus Charite Mitte: Charite Universitatsmedizin Berlin
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Charité - Universitätsmedizin Berlin
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Charite Universitatsmedizin Berlin Campus Charite Mitte: Charite Universitatsmedizin Berlin
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Charité - Universitätsmedizin Berlin
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Charite Universitatsmedizin Berlin Campus Charite Mitte: Charite Universitatsmedizin Berlin
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Ruhr University of Bochum Faculty of Medicine: Ruhr-Universitat Bochum Medizinische Fakultat
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University Hospital Bonn: Universitatsklinikum Bonn
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Evangelisches Krankenhaus Bethesda
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Evangelisches Krankenhaus BETHESDA zu Duisburg GmbH
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University Hospital Carl Gustav Carus
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Dresden University Hospital: Universitatsklinikum Carl Gustav Carus
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Düsseldorf University Hospital
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Universitätsklinikum Düsseldorf: Universitatsklinikum Dusseldorf
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Düsseldorf University Hospital
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Universitätsklinikum Düsseldorf: Universitatsklinikum Dusseldorf
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University Hospital Essen: Universitatsklinikum Essen
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University Hospital Essen: Universitatsklinikum Essen
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Universität Frankfurt am Main: Goethe-Universitat Frankfurt am Main
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University of Frankfurt: Goethe-Universitat Frankfurt am Main
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University Medical Center Freiburg
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Universitätsklinikum Freiburg: Universitatsklinikum Freiburg
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Universitätsmedizin Göttingen · University of Göttingen
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Georg-August-Universität Göttingen Universitätsmedizin: Georg-August-Universitat Gottingen Universitatsmedizin
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Universitätsmedizin Greifswald · Universität Greifswald
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Universitätsmedizin Greifswald: Universitatsmedizin Greifswald
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Universitatsklinikum Halle
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University Hospital Heidelberg
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University Hospital Heidelberg: UniversitatsKlinikum Heidelberg
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University Hospital Leipzig: Universitatsklinikum Leipzig
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Medizinische Universitat zu Lübeck: Universitat zu Lubeck
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Universitätsklinikum Magdeburg: Universitatsklinikum Magdeburg
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Universitätsklinikum Gießen und Marburg
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Universitätsklinikum Gießen und Marburg - Standort Marburg: Universitatsklinikum Giessen und Marburg - Standort Marburg
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Universitätsklinikum Gießen und Marburg
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Universitätsklinikum Gießen und Marburg Standort Gießen: Universitatsklinikum Giessen und Marburg GmbH Standort Giessen
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Technical University of Munich
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Technische Universitat Munchen
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Technical University of Munich
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Technische Universitat Munchen
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Oberschwabenklinik Ravensburg
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Universitätsklinikum des Saarlandes · Saarland University
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Saarland University Medical Center and Saarland University Faculty of Medicine: Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes
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University Hospital Ulm: Universitatsklinikum Ulm
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University Hospital Ulm: Universitatsklinikum Ulm
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Witten/Herdecke University: Universitat Witten/Herdecke
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Universitätsklinikum Würzburg: Universitatsklinikum Wurzburg
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Universitätsklinikum Würzburg: Universitatsklinikum Wurzburg
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University Hospitals Tubingen: Universitatsklinikum Tubingen
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Eberhard Karls University Tübingen Faculty of Medicine: Eberhard-Karls-Universitat Tubingen Medizinische Fakultat
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University Hospitals Tubingen: Universitatsklinikum Tubingen
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University Hospitals Tubingen: Universitatsklinikum Tubingen
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