Development and validation of a machine learning-based prediction model for near-term in-hospital mortality among patients with COVID-19. Issue Volume 12:Issue e3(2022) (22nd September 2020)

• Record Type: Journal Article
• Authors: Parchure, Prathamesh; Joshi, Himanshu; Dharmarajan, Kavita; Freeman, Robert; Reich, David L; Mazumdar, Madhu; Timsina, Prem; Kia, Arash
• Is Part Of: BMJ supportive & palliative care. Volume 12:Issue e3(2022)
• Page Start: e424
• Page End: e431
• Publication Date: 2020-09-22
• Subjects: end of life care -- hospital care -- prognosis -- supportive care -- terminal care; Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2020-002602
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Objectives: To develop and validate a model for prediction of near-term in-hospital mortality among patients with COVID-19 by application of a machine learning (ML) algorithm on time-series inpatient data from electronic health records. Methods: A cohort comprised of 567 patients with COVID-19 at a large acute care healthcare system between 10 February 2020 and 7 April 2020 observed until either death or discharge. Random forest (RF) model was developed on randomly drawn 70% of the cohort (training set) and its performance was evaluated on the rest of 30% (the test set). The outcome variable was in-hospital mortality within 20–84 hours from the time of prediction. Input features included patients' vital signs, laboratory data and ECG results. Results: Patients had a median age of 60.2 years (IQR 26.2 years); 54.1% were men. In-hospital mortality rate was 17.0% and overall median time to death was 6.5 days (range 1.3–23.0 days). In the test set, the RF classifier yielded a sensitivity of 87.8% (95% CI: 78.2% to 94.3%), specificity of 60.6% (95% CI: 55.2% to 65.8%), accuracy of 65.5% (95% CI: 60.7% to 70.0%), area under the receiver operating characteristic curve of 85.5% (95% CI: 80.8% to 90.2%) and area under the precision recall curve of 64.4% (95% CI: 53.5% to 75.3%). Conclusions: Our ML-based approach can be used to analyse electronic health record data and reliably predict near-term mortality prediction. Using such a model in hospitals could help improve care, thereby better aligning clinical decisions with prognosis in critically ill patients with COVID-19.