Background: Due to the rapid increase in the number of confirmed cases of COVID-19, particularly severe or critical ones, overwhelming of health systems has become a worldwide concern Therefore, identifying high-risk COVID-19 patients can help service providers with setting priorities and allocating medical resource Methods: The herein research was designed as a retrospective cohort study of COVID-19 patients 4542 confirmed COVID-19 adult patients admitted to 15 hospitals in Tehran, Iran, from February 20 to April 18, 2020 were included in this study Demographic features including age and sex, clinical outcome (survived or died) and laboratory data were extracted This laboratory data included Complete Blood Count (CBC) tests, liver function tests (LFT), muscle injury enzymes, arterial blood gases (ABG), creatinine, uric acid, electrolytes, 25-hydroxy vitamin D level, fasting blood sugar (FBS), D-Dimer, and C-reactive protein (CRP), which were recorded on admission, and compared for both recovered and deceased patients Data analysis was performed using the SPSS modeler software through data mining and machine learning methods Findings: Of the 4542 hospitalized adult patients, 822 (18·09%) died during hospitalization, and 3720 (81·90%) were discharged from the hospitals Many laboratory tests show significant differences between survived and deceased patients These differences are considered as predictors in this study Based on logistic regression (LR) models, older age, and liver enzymes such as alanine aminotransferase (ALT) ≥ 55 IU/ (RR=2·20, CI: 1·69-2·86), elevated aspartate aminotransferase (AST) reference range especially above 100 IU/L (RR=5·93, CI: 4·75-7·39), and alkaline phosphatase (ALP) above 200 IU/L (RR=2·46, CI: 1·80-3·37) are associated with a higher COVID-19 Mortality Rate (MR) Serum electrolytes including sodium below 135 mEq/l (RR=1·69, CI: 1·35-2·11), and above 145 mEq/l (RR=7·24, CI: 5·07-10·33), potassium ≥ 5·50 mEq/l (RR=7·53, CI: 4·15-13·64), and calcium below 8·50 mEq/l (RR=3·39, CI: 2·81-4·09) are also connected to an increased COVID-19 MR Also, elevated CPK range 307-600 IU/L (in male patients), and 192-400 IU/L (in female patients) (RR=2·73, CI: 2·12-3·53), and above 600 IU/L (in male patients) and above 400 (RR=4·41, CI: 3·40-5·71) (in female patients), CRP higher than the reference range, specially above 100 mg/l (RR=3·22, CI: 1·99-5·20), and creatinine more than 1·5 mg/l (RR=6·37, CI: 5·30-7·66) were found to be associated with COVID-19 MR Interpretation: Risk-factor evaluation of COVID-19 patients upon admission into hospitals can lead to a better resource allocation, allowing healthcare providers to offer better and more prompt care to those with severe conditions In this study, the most critical risk factors associated with high-risk patients in different age groups, were elevated creatinine, AST, ALP, and CPK, abnormal sodium level, and hypocalcemia
Identifying High-Risk COVID-19 Patients Based on Laboratory Tests Using Data Mining Approach