ICU admission and mortality classifiers for COVID-19 patients based on subgroups of dynamically associated profiles across multiple timepoints

Abstract

The coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is consistently causing profound wounds in the global healthcare system due to its increased transmissibility. Currently, there is an urgent unmet need to identify the underlying dynamic associations among COVID-19 patients and distinguish patient subgroups with common clinical profiles towards the development of robust classifiers for ICU admission and mortality. To address this need, we propose a four step pipeline which: (i) enhances the quality of multiple timeseries clinical data through an automated data curation workflow, (ii) deploys Dynamic Bayesian Networks (DBNs) for the detection of features with increased connectivity based on dynamic association analysis across multiple points, (iii) utilizes Self Organizing Maps (SOMs) and trajectory analysis for the early identification of COVID-19 patients with common clinical profiles, and (iv) trains robust multiple additive regression trees (MART) for ICU admission and mortality classification based on the extracted homogeneous clusters, to identify risk factors and biomarkers for disease progression. The contribution of the extracted clusters and the dynamically associated clinical data improved the classification performance for ICU admission to sensitivity 0.83 and specificity 0.83, and for mortality to sensitivity 0.74 and specificity 0.76. Additional information was included to enhance the performance of the classifiers yielding an increase by 4% in sensitivity and specificity for mortality. According to the risk factor analysis, the number of lymphocytes, SatO2, PO2/FiO2, and O2 supply type were highlighted as risk factors for ICU admission and the percentage of neutrophils and lymphocytes, PO2/FiO2, LDH, and ALP for mortality, among others. To our knowledge, this is the first study that combines dynamic modeling with clustering analysis to identify homogeneous groups of COVID-19 patients towards the development of robust classifiers for ICU admission and mortality.

Long-term oxygen therapy to reduce length of hospital stay in COVID-19

“…A study conducted in Italy in 2020 identified that, among patients who had recovered from the acute phase of the disease, 87.4% reported the persistence of at least one symptom, the most prevalent being fatigue, followed by shortness of breath 3 . These were also the two main complaints identified in another study conducted in the United Kingdom in the same year 4 . Several factors are associated with the persistence of these manifestations, such as persistent chronic inflammation, organic changes related to the disease, prolonged hospitalization, and associated intensive care 3 , 5 .…”

“…Typically, advanced age is linked with higher mortality rates and a greater need for critical care. Our sample, however, comprised of younger patients, prompting further investigation into unanalyzed factors like inflammatory markers or specific laboratory parameters that may account for these differences 4 .…”