Blood Transfusion, All-Cause Mortality and Hospitalization Period in COVID-19 Patients: Machine Learning Analysis of National Health Insurance Claims Data

Abstract

This study presents the most comprehensive machine-learning analysis for the predictors of blood transfusion, all-cause mortality, and hospitalization period in COVID-19 patients. Data came from Korea National Health Insurance claims data with 7943 COVID-19 patients diagnosed during November 2019−May 2020. The dependent variables were all-cause mortality and the hospitalization period, and their 28 independent variables were considered. Random forest variable importance (GINI) was introduced for identifying the main factors of the dependent variables and evaluating their associations with these predictors, including blood transfusion. Based on the results of this study, blood transfusion had a positive association with all-cause mortality. The proportions of red blood cell, platelet, fresh frozen plasma, and cryoprecipitate transfusions were significantly higher in those with death than in those without death (p-values < 0.01). Likewise, the top ten factors of all-cause mortality based on random forest variable importance were the Charlson Comorbidity Index (53.54), age (45.68), socioeconomic status (45.65), red blood cell transfusion (27.08), dementia (19.27), antiplatelet (16.81), gender (14.60), diabetes mellitus (13.00), liver disease (11.19) and platelet transfusion (10.11). The top ten predictors of the hospitalization period were the Charlson Comorbidity Index, socioeconomic status, dementia, age, gender, hemiplegia, antiplatelet, diabetes mellitus, liver disease, and cardiovascular disease. In conclusion, comorbidity, red blood cell transfusion, and platelet transfusion were the major factors of all-cause mortality based on machine learning analysis. The effective management of these predictors is needed in COVID-19 patients.

Keywords: COVID-19; blood transfusion; hospitalization; machine learning; mortality.

Figure 1

Random forest variable importance for death. Abbreviations: CHF, congestive heart failure; C-index, Charlson Comorbidity Index; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CTD, connective tissue disease; CVA, cardiovascular accident; DM, diabetes mellitus; FFP, fresh frozen plasma; MI, myocardial infarction; PLT, platelet; PUD, peptic ulcer disease; PVD, peripheral vascular disease; RBC, red blood cell.

Figure 2

Random forest variable importance for hospitalization period. Abbreviations: CHF, congestive heart failure; C-index, Charlson Comorbidity Index; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CTD, connective tissue disease; CVA, cardiovascular accident; DM, diabetes mellitus; FFP, fresh frozen plasma; MI, myocardial infarction; PLT, platelet; PUD, peptic ulcer disease; PVD, peripheral vascular disease; RBC, red blood cell.