Introduction The new coronavirus disease (COVID-19) is a challenge for clinical decision-making and the effective allocation of healthcare resources. An accurate prognostic assessment is necessary to improve survival of patients, especially in developing countries. This study proposes to predict the risk of developing critical conditions in COVID-19 patients by training multipurpose algorithms. Methods A total of 1,040 patients with a positive RT-PCR diagnosis for COVID-19 from a large hospital from Sao Paulo, Brazil, were followed from March to June 2020, of which 288 (28%) presented a severe prognosis, i.e. Intensive Care Unit (ICU) admission, use of mechanical ventilation or death. Routinely-collected laboratory, clinical and demographic data was used to train five machine learning algorithms (artificial neural networks, extra trees, random forests, catboost, and extreme gradient boosting). A random sample of 70% of patients was used to train the algorithms and 30% were left for performance assessment, simulating new unseen data. In order to assess if the algorithms could capture general severe prognostic patterns, each model was trained by combining two out of three outcomes to predict the other. Results All algorithms presented very high predictive performance (average AUROC of 0.92, sensitivity of 0.92, and specificity of 0.82). The three most important variables for the multipurpose algorithms were ratio of lymphocyte per C-reactive protein, C-reactive protein and Braden Scale. Conclusion The results highlight the possibility that machine learning algorithms are able to predict unspecific negative COVID-19 outcomes from routinely-collected data.
A multipurpose machine learning approach to predict COVID-19 negative prognosis in Sao Paulo, Brazil