An early-warning model to predict in-hospital mortality on admission of COVID-19 patients at an emergency department (ED) was developed and validate using a Machine-Learning model. In total, 2782 patients were enrolled between March 2020 and December 2020, including 2106 patients (first wave) and 676 patients (second wave) in the COVID-19 outbreak in Italy. The first-wave patients were divided into two groups with 1474 patients used to train the model, and 632 to validate it. The 676 patients in the second wave were used to test the model. Age, 17 blood analytes and Brescia chest X-ray score were the variables processed using a Random Forests classification algorithm to build and validate the model. ROC analysis was used to assess the model performances. A web-based death-risk calculator was implemented and integrated within the Laboratory Information System of the hospital. The final score was constructed by age (the most powerful predictor), blood analytes (the strongest predictors were lactate dehydrogenase, D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, Lymphocyte %, Ferritin std and Monocyte %), and Brescia chest X-ray score. The areas under the receiver operating characteristic curve obtained for the three groups (training, validating and testing) were 0.98, 0.83 and 0.78, respectively. The model predicts in-hospital mortality on the basis of data that can be obtained in a short time, directly at the ED on admission. It functions as a web-based calculator, providing a risk score which is easy to interpret. It can be used in the triage process to support the decision on patient allocation.
We are unable to share the dataset as it contains sensitive personal data collected during the pandemic at Spedali Civili di Brescia. We cannot share the full data since are data from patients. Interested researchers should contact the authors for any query related to data sharing and submit a project proposal Once defined the goal of the study, and the data needed authors will submit the potential project of collaboration to the IRB of Spedali Civili di Brescia to receive approval to access a deidentified dataset. Please note that other informations related to patients can be acquired, always following approoval of IRB of Spedali Civili di Brescia, not only the ones studied in the paper.Anyway, following request to the authors, it will be possible to share processed version of the dataset ( e.g. an Excel sheet with numbers used to plot the graphs and charts of the manuscript).All code used to analyse the data can be found on GitHub at https://github.com/biostatUniBS/BS_EWS
- Stefano Calza
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Human subjects: The Institutional review board aprpoved the study with the entry code NP4000.
- Evangelos J Giamarellos-Bourboulis, National and Kapodistrian University of Athens, Medical School, Greece
© 2021, Garrafa et al.
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