Artificial intelligence-driven prediction of COVID-19-related hospitalization and death: a systematic review

Abstract

Aim: To perform a systematic review on the use of Artificial Intelligence (AI) techniques for predicting COVID-19 hospitalization and mortality using primary and secondary data sources.

Study eligibility criteria: Cohort, clinical trials, meta-analyses, and observational studies investigating COVID-19 hospitalization or mortality using artificial intelligence techniques were eligible. Articles without a full text available in the English language were excluded.

Data sources: Articles recorded in Ovid MEDLINE from 01/01/2019 to 22/08/2022 were screened.

Data extraction: We extracted information on data sources, AI models, and epidemiological aspects of retrieved studies.

Bias assessment: A bias assessment of AI models was done using PROBAST.

Participants: Patients tested positive for COVID-19.

Results: We included 39 studies related to AI-based prediction of hospitalization and death related to COVID-19. The articles were published in the period 2019-2022, and mostly used Random Forest as the model with the best performance. AI models were trained using cohorts of individuals sampled from populations of European and non-European countries, mostly with cohort sample size <5,000. Data collection generally included information on demographics, clinical records, laboratory results, and pharmacological treatments (i.e., high-dimensional datasets). In most studies, the models were internally validated with cross-validation, but the majority of studies lacked external validation and calibration. Covariates were not prioritized using ensemble approaches in most of the studies, however, models still showed moderately good performances with Area under the Receiver operating characteristic Curve (AUC) values >0.7. According to the assessment with PROBAST, all models had a high risk of bias and/or concern regarding applicability.

Conclusions: A broad range of AI techniques have been used to predict COVID-19 hospitalization and mortality. The studies reported good prediction performance of AI models, however, high risk of bias and/or concern regarding applicability were detected.

Keywords: AI; COVID-19; PROBAST; bias; pharmacoepidemiology; predictive modeling.

Figure 1

Flowchart of the study selection process.

Figure 2

Descriptive analysis—part 1. (A): models, (B): data source, (C): type of data, (D): number of covariates. Extreme Gradient Boosting (XGB), Water Wave Optimization (WWO), Support Vector Machine (SVM), Inspired Modification of Partial Least Square (SIMPLS), SEKPS-CL, Random Forest (RF), Neural Network (NN), Naive Bayes (NB), Logistic Regression (LR), Linear Discriminant Analysis (LDA), Ensemble, Decision Tree (DT), Disease Risk Score.

Figure 3

Descriptive analysis - part 2. (A): study population size, (B): using external validation, (C): using internal validation, (D): using calibration, (E): study design, (F): using cross-validation.

Figure 4

Descriptive analysis - part 3. (A): using ensemble prioritization, (B): AUC, (C): overall accuracy.

Figure 5

Predictors of COVID 19-related hospitalization. (A): clinical predictors. (B): socio-demohraphics predictrs. (C): laboratory predictors.

Figure 6

Predictors of COVID-19-related mortality. (A): clinical predictors. (B): socio-demohraphics predictrs. (C): laboratory predictors.