{
    "abstract": "The aim of this study was to estimate a 48 hour prediction of moderate to severe respiratory failure, requiring mechanical ventilation, in hospitalized patients with COVID-19 pneumonia.\nThis was an observational prospective study that comprised consecutive patients with COVID-19 pneumonia admitted to hospital from 21 February to 6 April 2020. The patients' medical history, demographic, epidemiologic and clinical data were collected in an electronic patient chart. The dataset was used to train predictive models using an established machine learning framework leveraging a hybrid approach where clinical expertise is applied alongside a data-driven analysis. The study outcome was the onset of moderate to severe respiratory failure defined as PaO2/FiO2 ratio <150 mmHg in at least one of two consecutive arterial blood gas analyses in the following 48 hours. Shapley Additive exPlanations values were used to quantify the positive or negative impact of each variable included in each model on the predicted outcome.\nA total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-variables laboratory biomarkers and 91-variables as a composition of the two. A fourth \"boosted mixed model\" included 20 variables was selected from the model 3, achieved the best predictive performance (AUC = 0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example.\nThis study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels.",
    "authors": [
        {
            "affiliation": "Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.\nDepartment of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy.",
            "firstname": "Davide",
            "initials": "D",
            "lastname": "Ferrari"
        },
        {
            "affiliation": "Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.\nClinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.",
            "firstname": "Jovana",
            "initials": "J",
            "lastname": "Milic"
        },
        {
            "affiliation": "Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.\nRespiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Roberto",
            "initials": "R",
            "lastname": "Tonelli"
        },
        {
            "affiliation": "Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy.",
            "firstname": "Francesco",
            "initials": "F",
            "lastname": "Ghinelli"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Marianna",
            "initials": "M",
            "lastname": "Meschiari"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Sara",
            "initials": "S",
            "lastname": "Volpi"
        },
        {
            "affiliation": "Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Matteo",
            "initials": "M",
            "lastname": "Faltoni"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Giacomo",
            "initials": "G",
            "lastname": "Franceschi"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Vittorio",
            "initials": "V",
            "lastname": "Iadisernia"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Dina",
            "initials": "D",
            "lastname": "Yaacoub"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Giacomo",
            "initials": "G",
            "lastname": "Ciusa"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Erica",
            "initials": "E",
            "lastname": "Bacca"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Carlotta",
            "initials": "C",
            "lastname": "Rogati"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Marco",
            "initials": "M",
            "lastname": "Tutone"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Giulia",
            "initials": "G",
            "lastname": "Burastero"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Alessandro",
            "initials": "A",
            "lastname": "Raimondi"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Marianna",
            "initials": "M",
            "lastname": "Menozzi"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Erica",
            "initials": "E",
            "lastname": "Franceschini"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Gianluca",
            "initials": "G",
            "lastname": "Cuomo"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Luca",
            "initials": "L",
            "lastname": "Corradi"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Gabriella",
            "initials": "G",
            "lastname": "Orlando"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Antonella",
            "initials": "A",
            "lastname": "Santoro"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Margherita",
            "initials": "M",
            "lastname": "Digaetano"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Cinzia",
            "initials": "C",
            "lastname": "Puzzolante"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Federica",
            "initials": "F",
            "lastname": "Carli"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Vanni",
            "initials": "V",
            "lastname": "Borghi"
        },
        {
            "affiliation": "Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Bedini"
        },
        {
            "affiliation": "Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Riccardo",
            "initials": "R",
            "lastname": "Fantini"
        },
        {
            "affiliation": "Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Luca",
            "initials": "L",
            "lastname": "Tabb\u00ec"
        },
        {
            "affiliation": "Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.\nRespiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Ivana",
            "initials": "I",
            "lastname": "Castaniere"
        },
        {
            "affiliation": "Department of Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Stefano",
            "initials": "S",
            "lastname": "Busani"
        },
        {
            "affiliation": "Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.\nDepartment of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.",
            "firstname": "Enrico",
            "initials": "E",
            "lastname": "Clini"
        },
        {
            "affiliation": "Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.\nDepartment of Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Massimo",
            "initials": "M",
            "lastname": "Girardis"
        },
        {
            "affiliation": "Clinical Microbiology, Ospedale Civile di Baggiovara, Modena, Italy.",
            "firstname": "Mario",
            "initials": "M",
            "lastname": "Sarti"
        },
        {
            "affiliation": "Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Cossarizza"
        },
        {
            "affiliation": "Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.\nDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Cristina",
            "initials": "C",
            "lastname": "Mussini"
        },
        {
            "affiliation": "Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy.",
            "firstname": "Federica",
            "initials": "F",
            "lastname": "Mandreoli"
        },
        {
            "affiliation": "School of Computing, Newcastle University, Newcastle upon Tyne, United kingdom.",
            "firstname": "Paolo",
            "initials": "P",
            "lastname": "Missier"
        },
        {
            "affiliation": "Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.\nDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.",
            "firstname": "Giovanni",
            "initials": "G",
            "lastname": "Guaraldi"
        }
    ],
    "conclusions": "This study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels.",
    "copyrights": null,
    "doi": "10.1371/journal.pone.0239172\n10.1016/S0140-6736(20)30566-3\n10.1097/ALN.0000000000003296\n10.1001/jama.2018.17163\n10.1016/j.metabol.2017.01.011\n10.1002/cyto.a.23990\n10.1136/bmj.m1328\n10.1056/NEJMoa2001282\n10.1371/journal.pmed.1002707\n10.1093/ehjci/jez160\n10.1001/jamainternmed.2020.2033\n10.1186/s12967-020-02374-0\n10.1038/s41591-020-0968-3\n10.1136/bmjopen-2017-018880\n10.1148/radiol.2020201433",
    "journal": "PloS one",
    "keywords": [],
    "methods": null,
    "publication_date": "2020-11-13",
    "pubmed_id": "33180787\n32171076\n32209164\n32109013\n32195705\n30398550\n28126242\n32142596\n32265220\n32187464\n30500815\n31230076\n32396163\n32434518\n32651579\n31922560\n29330175\n32301647",
    "results": "A total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-variables laboratory biomarkers and 91-variables as a composition of the two. A fourth \"boosted mixed model\" included 20 variables was selected from the model 3, achieved the best predictive performance (AUC = 0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example.",
    "title": "Machine learning in predicting respiratory failure in patients with COVID-19 pneumonia-Challenges, strengths, and opportunities in a global health emergency.",
    "xml": "<Element 'PubmedArticle' at 0x7885065cbec0>"
}