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      Predicting survival of Iranian COVID-19 patients infected by various variants including omicron from CT Scan images and clinical data using deep neural networks

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          Abstract

          Purpose: The rapid spread of the COVID-19 omicron variant virus has resulted in an overload of hospitals around the globe. As a result, many patients are deprived of hospital facilities, increasing mortality rates. Therefore, mortality rates can be reduced by efficiently assigning facilities to higher-risk patients. Therefore, it is crucial to estimate patients' survival probability based on their conditions at the time of admission so that the minimum required facilities can be provided, allowing more opportunities to be available for those who need them. Although radiologic findings in chest computerized tomography scans show various patterns, considering the individual risk factors and other underlying diseases, it is difficult to predict patient prognosis through routine clinical or statistical analysis.

          Method: In this study, a deep neural network model is proposed for predicting survival based on simple clinical features, blood tests, axial computerized tomography scan images of lungs, and the patients' planned treatment. The model's architecture combines a Convolutional Neural Network and a Long Short Term Memory network. The model was trained using 390 survivors and 108 deceased patients from the Rasoul Akram Hospital and evaluated 109 surviving and 36 deceased patients infected by the omicron variant.

          Results: The proposed model reached an accuracy of 87.5% on the test data, indicating survival prediction possibility. The accuracy was significantly higher than the accuracy achieved by classical machine learning methods without considering computerized tomography scan images (p-value <= 4E-5). The images were also replaced with hand-crafted features related to the ratio of infected lung lobes used in classical machine-learning models. The highest-performing model reached an accuracy of 84.5%, which was considerably higher than the models trained on mere clinical information (p-value <= 0.006). However, the performance was still significantly less than the deep model (p-value <= 0.016).

          Conclusion: The proposed deep model achieved a higher accuracy than classical machine learning methods trained on features other than computerized tomography scan images. This proves the images contain extra information. Meanwhile, Artificial Intelligence methods with multimodal inputs can be more reliable and accurate than computerized tomography severity scores.

          Highlights

          • A DNN model was proposed for predicting survival based on clinical features, axial CT scan images of lungs and the patients' planned treatment.

          • The proposed model achieves an accuracy of 87.3% on the test data, indicating survival prediction possibility.

          • The results suggest the proposed DNN model extracts and utilizes information not captured by classical machine learning methods.

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          Most cited references48

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          COVID-19 and the cardiovascular system

          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells through ACE2 receptors, leading to coronavirus disease (COVID-19)-related pneumonia, while also causing acute myocardial injury and chronic damage to the cardiovascular system. Therefore, particular attention should be given to cardiovascular protection during treatment for COVID-19.
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            Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis

            Introduction An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date. Methods We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI). Results 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5–92.9%), cough (57.6%, 95%CI 40.8–74.4%) and dyspnea (45.6%, 95%CI 10.9–80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0–30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7–51.8), 6.2% (95%CI 3.1–9.3) with shock. Some 13.9% (95%CI 6.2–21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR). Conclusion COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.
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              Nervous system involvement after infection with COVID-19 and other coronaviruses

              Highlights • Coronoviruses not only affect the respiratory system, but also have deleterious effects on the central nervous system. • Most neurological diseases could be caused by coronoviruses invasion. • Coronoviruses cause nerve damage via diverse pathways.
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                08 November 2023
                November 2023
                08 November 2023
                : 9
                : 11
                : e21965
                Affiliations
                [a ]Radiology Department, Hazrat Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Hemmat, Tehran, 14535, Iran
                [b ]Data science and Machine learning Lab, Department of Computer Engineering, Sharif University of Technology, Azadi, Tehran, 11365-8639, Iran
                [c ]BCB Lab, Department of Computer Engineering, Sharif University of Technology, Azadi, Tehran, 11365-8639, Iran
                [d ]AI-Med Group, AI Innovation Center, Sharif University of Technology, Azadi, Tehran, 11365-8639, Iran
                Author notes
                [* ]Corresponding author at: Data science and Machine learning Lab, Department of Computer Engineering, Sharif University of Technology, Azadi, Tehran, 11365-8639, Iran. rabiee@ 123456sharif.edu
                Article
                S2405-8440(23)09173-9 e21965
                10.1016/j.heliyon.2023.e21965
                10696006
                38058649
                c84a54bc-67e5-4ae3-afa7-1883e0d00bfc
                © 2023 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 12 October 2022
                : 26 October 2023
                : 1 November 2023
                Categories
                Research Article

                computer-aided diagnosis,computerized tomography imaging,deep neural networks,omicron variant,multimodal analysis

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