Development of a Clinical Decision Support System for Severity Risk Prediction and Triage of COVID-19 Patients at Hospital Admission: an International Multicenter Study
Authors: Wu Guangyao , Yang Pei , Woodruff Henry C. , Rao Xiangang , Guiot Julien , Frix Anne-Noelle , Moutschen Michel , Louis Renaud , Li Jiawei , Li Jing , Yan Chenggong , Du Dan , Zhao Shengchao , Ding Yi , Liu Bin , Sun Wenwu , Albarello Fabrizio , D’Abramo Alessandra , Schininà Vincenzo , Nicastri Emanuele , Occhipinti Mariaelena , Barisione Giovanni , Barisione Emanuela , Halilaj Iva , Xie Yuanliang , Wang Xiang , Lovinfosse Pierre , Wu Jianlin , Lambin Philippe 
Published: May 2020

Key pointsQuestionHow do nomograms and machine-learning algorithms of severity risk prediction and triage of COVID-19 patients at hospital admission perform?FindingsThis model was prospectively validated on six test datasets comprising of 426 patients and yielded AUCs ranging from 0.816 to 0.976, accuracies ranging from 70.8% to 93.8%, sensitivities ranging from 83.7% to 100%, and specificities ranging from 41.0% to 95.7%. The cut-off probability values for low, medium, and high-risk groups were 0.072 and 0.244.MeaningThe findings of this study suggest that our models performs well for the diagnosis and prediction of progression to severe or critical illness of COVID-19 patients and could be used for triage of COVID-19 patients at hospital admission.IMPORTANCEThe outbreak of the coronavirus disease 2019 (COVID-19) has globally strained medical resources and caused significant mortality for severely and critically ill patients. However, the availability of validated nomograms and the machine-learning model to predict severity risk and triage of affected patients is limited.OBJECTIVETo develop and validate nomograms and machine-learning models for severity risk assessment and triage for COVID-19 patients at hospital admission.DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort of 299 consecutively hospitalized COVID-19 patients at The Central Hospital of Wuhan, China, from December 23, 2019, to February 13, 2020, was used to train and validate the models. Six cohorts with 426 patients from eight centers in China, Italy, and Belgium, from February 20, 2020, to March 21, 2020, were used to prospectively validate the models.MAIN OUTCOME AND MEASURESThe main outcome was the onset of severe or critical illness during hospitalization. Model performances were quantified using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity.RESULTSOf the 299 hospitalized COVID-19 patients in the retrospective cohort, the median age was 50 years ((interquartile range, 35.5-63.0; range, 20–94 years) and 137 (45.8%) were men. Of the 426 hospitalized COVID-19 patients in the prospective cohorts, the median age was 62.0 years ((interquartile range, 50.0-72.0; range, 19-94 years) and 236 (55.4%) were men. The model was prospectively validated on six cohorts yielding AUCs ranging from 0.816 to 0.976, with accuracies ranging from 70.8% to 93.8%, sensitivities ranging from 83.7% to 100%, and specificities ranging from 41.0% to 95.7%. The cut-off values of the low, medium, and high-risk probabilities were 0.072 and 0.244. The developed online calculators can be found at https://covid19risk.ai/.CONCLUSION AND RELEVANCEThe machine learning models, nomograms, and online calculators might be useful for the prediction of onset of severe and critical illness among COVID-19 patients and triage at hospital admission. Further prospective research and clinical feedback are necessary to evaluate the clinical usefulness of this model and to determine whether these models can help optimize medical resources and reduce mortality rates compared with current clinical practices.