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https://www.arca.fiocruz.br/handle/icict/63035
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2030-12-31
Sustainable Development Goals
04 Educação de qualidadeCollections
- INI - Artigos de Periódicos [3646]
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DEVELOPMENT AND VALIDATION OF A MACHINE LEARNING MODEL TO PREDICT THE USE OF RENAL REPLACEMENT THERAPY IN 14,374 PATIENTS WITH COVID-19
Respiratory Failure
Acute Kidney Injury
Outcomes
Machine Learning
Renal Replacement Therapy
Author
Affilliation
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Clinical Research Laboratory in Intensive Medicine. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil / Hospital Copa Star. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Clinical Research Laboratory in Intensive Medicine. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil / Hospital Copa Star. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Postgraduate Program of Internal Medicine. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Abstract
Purpose: To develop a model to predict the use of renal replacement therapy (RRT) in COVID-19 patients. Materials and methods: Retrospective analysis of multicenter cohort of intensive care unit (ICU) admissions of Brazil involving COVID-19 critically adult patients, requiring ventilatory support, admitted to 126 Brazilian ICUs, from February 2020 to December 2021 (development) and January to May 2022 (validation). No interventions were performed. Results: Eight machine learning models' classifications were evaluated. Models were developed using an 80/20 testing/train split ratio and cross-validation. Thirteen candidate predictors were selected using the Recursive Feature Elimination (RFE) algorithm. Discrimination and calibration were assessed. Temporal validation was performed using data from 2022. Of 14,374 COVID-19 patients with initial respiratory support, 1924 (13%) required RRT. RRT patients were older (65 [53-75] vs. 55 [42-68]), had more comorbidities (Charlson's Comorbidity Index 1.0 [0.00-2.00] vs 0.0 [0.00-1.00]), had higher severity (SAPS-3 median: 61 [51-74] vs 48 [41-58]), and had higher in-hospital mortality (71% vs 22%) compared to non-RRT. Risk factors for RRT, such as Creatinine, Glasgow Coma Scale, Urea, Invasive Mechanical Ventilation, Age, Chronic Kidney Disease, Platelets count, Vasopressors, Noninvasive Ventilation, Hypertension, Diabetes, modified frailty index (mFI) and Gender, were identified. The best discrimination and calibration were found in the Random Forest (AUC [95%CI]: 0.78 [0.75-0.81] and Brier's Score: 0.09 [95%CI: 0.08-0.10]). The final model (Random Forest) showed comparable performance in the temporal validation (AUC [95%CI]: 0.79 [0.75-0.84] and Brier's Score, 0.08 [95%CI: 0.08-0.1]). Conclusions: An early ML model using easily available clinical and laboratory data accurately predicted the use of RRT in critically ill patients with COVID-19. Our study demonstrates that using ML techniques is feasible to provide early prediction of use of RRT in COVID-19 patients.
Keywords
COVID-19Respiratory Failure
Acute Kidney Injury
Outcomes
Machine Learning
Renal Replacement Therapy
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