O'Shea Aileen, Li Matthew D, Mercaldo Nathaniel D, Balthazar Patricia, Som Avik, Yeung Tristan, Succi Marc D, Little Brent P, Kalpathy-Cramer Jayashree, Lee Susanna I
Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.
Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, United States.
BJR Open. 2022 Mar 24;4(1):20210062. doi: 10.1259/bjro.20210062. eCollection 2022.
OBJECTIVE: To predict short-term outcomes in hospitalized COVID-19 patients using a model incorporating clinical variables with automated convolutional neural network (CNN) chest radiograph analysis. METHODS: A retrospective single center study was performed on patients consecutively admitted with COVID-19 between March 14 and April 21 2020. Demographic, clinical and laboratory data were collected, and automated CNN scoring of the admission chest radiograph was performed. The two outcomes of disease progression were intubation or death within 7 days and death within 14 days following admission. Multiple imputation was performed for missing predictor variables and, for each imputed data set, a penalized logistic regression model was constructed to identify predictors and their functional relationship to each outcome. Cross-validated area under the characteristic (AUC) curves were estimated to quantify the discriminative ability of each model. RESULTS: 801 patients (median age 59; interquartile range 46-73 years, 469 men) were evaluated. 36 patients were deceased and 207 were intubated at 7 days and 65 were deceased at 14 days. Cross-validated AUC values for predictive models were 0.82 (95% CI, 0.79-0.86) for death or intubation within 7 days and 0.82 (0.78-0.87) for death within 14 days. Automated CNN chest radiograph score was an important variable in predicting both outcomes. CONCLUSION: Automated CNN chest radiograph analysis, in combination with clinical variables, predicts short-term intubation and death in patients hospitalized for COVID-19 infection. Chest radiograph scoring of more severe disease was associated with a greater probability of adverse short-term outcome. ADVANCES IN KNOWLEDGE: Model-based predictions of intubation and death in COVID-19 can be performed with high discriminative performance using admission clinical data and convolutional neural network-based scoring of chest radiograph severity.
目的:使用一个将临床变量与自动卷积神经网络(CNN)胸部X光片分析相结合的模型,预测新冠肺炎住院患者的短期预后。 方法:对2020年3月14日至4月21日期间连续收治的新冠肺炎患者进行回顾性单中心研究。收集人口统计学、临床和实验室数据,并对入院时的胸部X光片进行自动CNN评分。疾病进展的两个结局分别是入院后7天内插管或死亡以及入院后14天内死亡。对缺失的预测变量进行多重填补,针对每个填补数据集,构建一个惩罚逻辑回归模型以识别预测因素及其与每个结局的函数关系。估计特征曲线下的交叉验证面积(AUC)以量化每个模型的判别能力。 结果:共评估了801例患者(中位年龄59岁;四分位间距46 - 73岁,男性469例)。36例患者死亡,207例在7天时插管,65例在14天时死亡。预测模型的交叉验证AUC值在入院后7天内死亡或插管的为0.82(95%CI,0.79 - 0.86),入院后14天内死亡的为0.82(0.78 - 0.87)。自动CNN胸部X光片评分是预测这两个结局的重要变量。 结论:自动CNN胸部X光片分析结合临床变量,可预测新冠肺炎感染住院患者的短期插管和死亡情况。病情更严重的胸部X光片评分与不良短期结局的可能性更大相关。 知识进展:使用入院临床数据和基于卷积神经网络的胸部X光片严重程度评分,可对新冠肺炎患者的插管和死亡进行具有高判别性能的基于模型的预测。
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