COVID-19 Risk Stratification and Mortality Prediction in Hospitalized Indian Patients

The clinical course of coronavirus disease 2019 (COVID-19) infection is highly variable with the vast majority recovering uneventfully but a small fraction progressing to severe disease and death. Appropriate and timely supportive care can reduce mortality and it is critical to evolve better patient risk stratification based on simple clinical data, so as to perform effective triage during strains on the healthcare infrastructure. This study presents risk stratification and mortality prediction models based on usual clinical data from 544 COVID-19 patients from New Delhi, India using machine learning methods. An XGboost classifier yielded the best performance on risk stratification (F1 score of 0.81). A logistic regression model yielded the best performance on mortality prediction (F1 score of 0.71). Significant biomarkers for predicting risk and mortality were identified. Examination of the data in comparison to a similar dataset with a Wuhan cohort of 375 patients was undertaken to understand the much lower mortality rates in India and the possible reasons thereof. The comparison indicated higher survival rate in the Delhi cohort even when patients had similar parameters as the Wuhan patients who died. Steroid administration was very frequent in Delhi patients, especially in surviving patients whose biomarkers indicated severe disease. This study helps in identifying the high-risk patient population and suggests treatment protocols that may be useful in countries with high mortality rates.