Predicting clinical outcomes at hospital admission of patients with COVID-19 pneumonia using artificial intelligence: a secondary analysis of a randomized clinical trial.

Background: Predicting clinical improvement after hospital admission in patients with COVID-19 is crucial for effective resource allocation. Machine-learning tools can help identify patients likely to show clinical improvement based on real-world data. This study used two approaches-least absolute shrinkage and selection operator (LASSO) and CombiROC-to identify predictive variables at hospital admission for detecting clinical improvement after 7 days. Methods: A secondary analysis was conducted on the modified intention-to-treat placebo group from a previous randomized clinical trial (RCT, NCT04561219) of patients with COVID-19. The analysis assessed clinical, laboratory, and blood markers at admission to predict clinical improvement, defined as a two-point increase on the World Health Organization clinical progression scale after 7 days. LASSO and CombiROC were used to select optimal predictive variables. The Youden criteria identified the best threshold for different variable combinations, which were then compared based on the highest area under the curve (AUC) and accuracy. AUCs were compared using DeLong's algorithm. Results: Overall, 203 patients were included in the analysis, and they were divided into two groups; clinical improvement ( Conclusion: For patients hospitalized with COVID-19 pneumonia, predictive variables identified by LASSO and CombiROC analyses demonstrated similar accuracy and AUCs in predicting clinical improvement. LASSO, with fewer variables (SaO Clinical trial registration: Brazilian Registry of Clinical Trials (REBEC) number RBR-88bs9x and ClinicalTrials.gov number NCT04561219.