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Machine learning in predicting respiratory failure in patients with COVID-19 pneumonia —Challenges, strengths, and opportunities in a global health emergency

Lookup NU author(s): Professor Federica Mandreoli, Professor Paolo MissierORCiD



Copyright: © 2020 Ferrari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Aims The aim of this study was to estimate a 48 hour prediction of moderate to severe respiratory failure, requiring mechanical ventilation, in hospitalized patients with COVID-19 pneumonia. Methods This was an observational prospective study that comprised consecutive patients with COVID-19 pneumonia admitted to hospital from 21 February to 6 April 2020. The patients’ medical history, demographic, epidemiologic and clinical data were collected in an electronic patient chart. The dataset was used to train predictive models using an established machine learning framework leveraging a hybrid approach where clinical expertise is applied alongside a data-driven analysis. The study outcome was the onset of moderate to severe respiratory failure defined as PaO2/FiO2 ratio <150 mmHg in at least one of two consecutive arterial blood gas analyses in the following 48 hours. Shapley Additive exPlanations values were used to quantify the positive or negative impact of each variable included in each model on the predicted outcome. Results A total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-vari-ables laboratory biomarkers and 91-variables as a composition of the two. A fourth “boosted mixed model” included 20 variables was selected from the model 3, achieved the best predictive performance (AUC = 0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example. Conclusion This study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels.

Publication metadata

Author(s): Ferrari D, Milic J, Tonelli R, Ghinelli F, Meschiari M, Volpi S, Faltoni M, Franceschi G, Iadisernia V, Yaacoub D, Ciusa G, Bacca E, Rogati C, Tutone M, Burastero G, Raimondi A, Menozzi M, Franceschini E, Cuomo G, Corradi L, Orlando G, Santoro A, Digaetano M, Puzzolante C, Carli F, Borghi V, Bedini A, Fantini R, Tabbi L, Castaniere I, Busani S, Clini E, Girardis M, Sarti M, Cossarizza A, Mussini C, Mandreoli F, Missier P, Guaraldi G

Publication type: Article

Publication status: Published

Journal: PLoS ONE

Year: 2020

Volume: 15

Issue: 11

Print publication date: 01/11/2020

Online publication date: 12/11/2020

Acceptance date: 02/09/2020

Date deposited: 10/12/2020

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0239172

PubMed id: 33180787


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