A Multi-Center Study of COVID-19 Patient Prognosis Using Deep Learning-based CT Image Analysis and Electronic Health Records

Gong, Kuang; Wu, Dufan; Arru, Chiara Daniela; Homayounieh, Fatemeh; Neumark, Nir; Guan, Jiahui; Buch, Varun; Kim, Kyungsang; Bizzo, Bernardo Canedo; Ren, Hui; Tak, Won Young; Park, Soo Young; Lee, Yu Rim; Kang, Min Kyu; Park, Jung Gil; Carriero, Alessandro; Saba, Luca; Masjedi, Mahsa; Talari, Hamidreza; Babaei, Rosa; Mobin, Hadi Karimi; Ebrahimian, Shadi; Guo, Ning; Digumarthy, Subba R.; Dayan, Ittai; Kalra, Mannudeep K.; Li, Quanzheng

PURPOSE: As of August 30th, there were in total 25.1 million confirmed cases and 845 thousand deaths caused by coronavirus disease of 2019 (COVID-19) worldwide. With overwhelming demands on medical resources, patient stratification based on their risks is essential. In this multi-center study, we built prognosis models to predict severity outcomes, combining patients’ electronic health records (EHR), which included vital signs and laboratory data, with deep learning- and CT-based severity prediction. METHOD: We first developed a CT segmentation network using datasets from multiple institutions worldwide. Two biomarkers were extracted from the CT images : total opacity ratio (TOR) and consolidation ratio (CR). After obtaining TOR and CR, further prognosis analysis was conducted on datasets from INSTITUTE-1, INSTITUTE-2 and INSTITUTE-3. For each data cohort, generalized linear model (GLM) was applied for prognosis prediction. RESULTS: For the deep learning model, the correlation coefficient of the network prediction and manual segmentation was 0.755, 0.919, and 0.824 for the three cohorts, respectively. The AUC (95% CI) of the final prognosis models was 0.85(0.77,0.92), 0.93(0.87,0.98), and 0.86(0.75,0.94) for INSTITUTE-1, INSTITUTE-2 and INSTITUTE-3 cohorts, respectively. Either TOR or CR exist in all three final prognosis models. Age, white blood cell (WBC), and platelet (PLT) were chosen predictors in two cohorts. Oxygen saturation (SpO2) was a chosen predictor in one cohort. CONCLUSION: The developed deep learning method can segment lung infection regions. Prognosis results indicated that age, SpO2, CT biomarkers, PLT, and WBC were the most important prognostic predictors of COVID-19 in our prognosis model.