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20 results on '"Smit, Ellen G. M."'

1. A pragmatic approach to estimating average treatment effects from EHR data: the effect of prone positioning on mechanically ventilated COVID-19 patients

Author

Izdebski, Adam, Thoral, Patrick J., Lalisang, Robbert C. A., McHugh, Dean M., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco A. A., Kamps, Marlijn J. A, Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., Tempel, Walter van den, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Fleuren, Lucas M., Dam, Tariq A., Tonutti, Michele, de Bruin, Daan P., Elbers, Paul W. G., and Cinà, Giovanni

Subjects
Computer Science - Machine Learning, Computer Science - Artificial Intelligence
Abstract

Despite the recent progress in the field of causal inference, to date there is no agreed upon methodology to glean treatment effect estimation from observational data. The consequence on clinical practice is that, when lacking results from a randomized trial, medical personnel is left without guidance on what seems to be effective in a real-world scenario. This article proposes a pragmatic methodology to obtain preliminary but robust estimation of treatment effect from observational studies, to provide front-line clinicians with a degree of confidence in their treatment strategy. Our study design is applied to an open problem, the estimation of treatment effect of the proning maneuver on COVID-19 Intensive Care patients.

Published
2021

2. Predicting responders to prone positioning in mechanically ventilated patients with COVID-19 using machine learning

Author

Dam, Tariq A., Roggeveen, Luca F., van Diggelen, Fuda, Fleuren, Lucas M., Jagesar, Ameet R., Otten, Martijn, de Vries, Heder J., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco A. A., Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Machado, Tomas, Herter, Willem E., de Grooth, Harm-Jan, Thoral, Patrick J., Girbes, Armand R. J., Hoogendoorn, Mark, and Elbers, Paul W. G.

Published
2022
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3. Predictors for extubation failure in COVID-19 patients using a machine learning approach

Author

Fleuren, Lucas M., Dam, Tariq A., Tonutti, Michele, de Bruin, Daan P., Lalisang, Robbert C. A., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco, Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Fornasa, Mattia, Machado, Tomas, Houwert, Taco, Hovenkamp, Hidde, Noorduijn Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G., de Beer, Aletta A., Cinà, Giovanni, Kantorik, Adam, de Ruijter, Tom, Herter, Willem E., Beudel, Martijn, Girbes, Armand R. J., Hoogendoorn, Mark, Thoral, Patrick J., and Elbers, Paul W. G.

Published
2021
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4. The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients

Author

Fleuren, Lucas M., Dam, Tariq A., Tonutti, Michele, de Bruin, Daan P., Lalisang, Robbert C. A., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco, Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Fornasa, Mattia, Machado, Tomas, Houwert, Taco, Hovenkamp, Hidde, Noorduijn-Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G., de Beer, Aletta A., Cina, Giovanni, Beudel, Martijn, Herter, Willem E., Girbes, Armand R. J., Hoogendoorn, Mark, Thoral, Patrick J., and Elbers, Paul W. G.

Published
2021
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5. Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome

Author

Dam, Tariq A., de Grooth, Harm-Jan, Klausch, Thomas, Fleuren, Lucas M., de Bruin, Daan P., Entjes, Robert, Rettig, Thijs C. D., Dongelmans, Dave A., Boelens, Age D., Rigter, Sander, Hendriks, Stefaan H. A., de Jong, Remko, Kamps, Marlijn J. A, Peters, Marco, Karakus, A., Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P. C., Nooteboom, Fleur G. C. A., Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D., Reidinga, Auke C., de Ruijter, Wouter, Bosman, Rob J., Frenzel, Tim, Urlings-Strop, Louise C., de Jong, Paul, Smit, Ellen G. M., Cremer, Olaf L., Mehagnoul-Schipper, D. Jannet, Faber, Harald J., Lens, Judith, Brunnekreef, Gert B., Festen-Spanjer, Barbara, Dormans, Tom, Dijkstra, Annemieke, Simons, Bram, Rijkeboer, A. A., Arbous, Sesmu, Aries, Marcel, Beukema, Menno, Pretorius, Daniël, van Raalte, Rutger, van Tellingen, Martijn, Gritters van den Oever, Niels C., Lalisang, Robbert C. A., Tonutti, Michele, Girbes, Armand R. J., Hoogendoorn, Mark, Thoral, Patrick J., and Elbers, Paul W. G.

Published
2021
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6. Incidence, Risk Factors and Outcome of Suspected Central Venous Catheter-related Infections in Critically Ill COVID-19 Patients: A Multicenter Retrospective Cohort Study

Author

Medische Staf Intensive Care, Infection & Immunity, MMB Medische Staf, Exterkate, Lotte, van Tienhoven, Arne J, Haaksma, Mark E, Heldeweg, Micah L A, Fleuren, Lucas, Thoral, Patrick, Dam, Tariq A, Heunks, Leo M A, Gommers, Diederik, Cremer, Olaf L, Bosman, Rob J, Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Vlaar, Alexander P, Dongelmans, Dave A, de Jong, Remko, Peters, Marco, Kamps, Marlijn J A, Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G C A, de Ruijter, Wouter, Urlings-Strop, Louise C, Smit, Ellen G M, Mehagnoul-Schipper, D Jannet, Dormans, Tom, de Jager, Cornelis P C, Hendriks, Stefaan H A, Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C, Festen-Spanjer, Barbara, Brunnekreef, Gert B, Cornet, Alexander D, van den Tempel, Walter, Boelens, Age D, Koetsier, Peter, Lens, Judith, Faber, Harald J, Karakus, A, Entjes, Robert, de Jong, Paul, Rettig, Thijs C D, Arbous, Sesmu, Vonk, Bas, Machado, Tomas, Girbes, Armand R J, Sieswerda, Elske, Elbers, Paul W G, Tuinman, Pieter R, Medische Staf Intensive Care, Infection & Immunity, MMB Medische Staf, Exterkate, Lotte, van Tienhoven, Arne J, Haaksma, Mark E, Heldeweg, Micah L A, Fleuren, Lucas, Thoral, Patrick, Dam, Tariq A, Heunks, Leo M A, Gommers, Diederik, Cremer, Olaf L, Bosman, Rob J, Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Vlaar, Alexander P, Dongelmans, Dave A, de Jong, Remko, Peters, Marco, Kamps, Marlijn J A, Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G C A, de Ruijter, Wouter, Urlings-Strop, Louise C, Smit, Ellen G M, Mehagnoul-Schipper, D Jannet, Dormans, Tom, de Jager, Cornelis P C, Hendriks, Stefaan H A, Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C, Festen-Spanjer, Barbara, Brunnekreef, Gert B, Cornet, Alexander D, van den Tempel, Walter, Boelens, Age D, Koetsier, Peter, Lens, Judith, Faber, Harald J, Karakus, A, Entjes, Robert, de Jong, Paul, Rettig, Thijs C D, Arbous, Sesmu, Vonk, Bas, Machado, Tomas, Girbes, Armand R J, Sieswerda, Elske, Elbers, Paul W G, and Tuinman, Pieter R

Published
2022

7. Rapid evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in-hospital mortality

Author

Medische Staf Intensive Care, Infection & Immunity, Plečko, Drago, Bennett, Nicolas, Mårtensson, Johan, Dam, Tariq A, Entjes, Robert, Rettig, Thijs C D, Dongelmans, Dave A, Boelens, Age D, Rigter, Sander, Hendriks, Stefaan H A, de Jong, Remko, Kamps, Marlijn J A, Peters, Marco, Karakus, Attila, Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P C, Nooteboom, Fleur G C A, Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D, Reidinga, Auke C, de Ruijter, Wouter, Bosman, Rob J, Frenzel, Tim, Urlings-Strop, Louise C, de Jong, Paul, Smit, Ellen G M, Cremer, Olaf L, Mehagnoul-Schipper, D Jannet, Faber, Harald J, Lens, Judith, Brunnekreef, Gert B, Festen-Spanjer, Barbara, Dormans, Tom, de Bruin, Daan P, Lalisang, Robbert C A, Vonk, Sebastiaan J J, Haan, Martin E, Fleuren, Lucas M, Thoral, Patrick J, Elbers, Paul W G, Bellomo, Rinaldo, Medische Staf Intensive Care, Infection & Immunity, Plečko, Drago, Bennett, Nicolas, Mårtensson, Johan, Dam, Tariq A, Entjes, Robert, Rettig, Thijs C D, Dongelmans, Dave A, Boelens, Age D, Rigter, Sander, Hendriks, Stefaan H A, de Jong, Remko, Kamps, Marlijn J A, Peters, Marco, Karakus, Attila, Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P C, Nooteboom, Fleur G C A, Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D, Reidinga, Auke C, de Ruijter, Wouter, Bosman, Rob J, Frenzel, Tim, Urlings-Strop, Louise C, de Jong, Paul, Smit, Ellen G M, Cremer, Olaf L, Mehagnoul-Schipper, D Jannet, Faber, Harald J, Lens, Judith, Brunnekreef, Gert B, Festen-Spanjer, Barbara, Dormans, Tom, de Bruin, Daan P, Lalisang, Robbert C A, Vonk, Sebastiaan J J, Haan, Martin E, Fleuren, Lucas M, Thoral, Patrick J, Elbers, Paul W G, and Bellomo, Rinaldo

Published
2022

8. Additional file 1 of Predicting responders to prone positioning in mechanically ventilated patients with COVID-19 using machine learning

Author

Dam, Tariq A., Roggeveen, Luca F., van Diggelen, Fuda, Fleuren, Lucas M., Jagesar, Ameet R., Otten, Martijn, de Vries, Heder J., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco A. A., Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Machado, Tomas, Herter, Willem E., de Grooth, Harm-Jan, Thoral, Patrick J., Girbes, Armand R. J., Hoogendoorn, Mark, and Elbers, Paul W. G.

Abstract

Additional file 1: Table S1. Parameter bounds. Table S2. Parameter categories. Table S3. Feature derivations. Table S4. Included features. Table S5. Hyper parameter optimization. Table S6. Feature Importance Metrics. Table S7. Patient characteristics. Table S8. ROC AUC score. Table S9. F1-score. Table S10. Sensitivity Analysis Minimal Prone Duration. Table S11. Sensitivity Analysis Cut-off Values. Table S12. Ranked Feature Importance. Table S13. Feature Importance Values. Figure S1. PaO2/FiO2 ratio difference in mmHg over time after starting prone position. Prone positions which continued for longer than 24 hours were filtered out.

Published
2022
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9. Additional file 1 of Risk factors for adverse outcomes during mechanical ventilation of 1152 COVID-19 patients: a multicenter machine learning study with highly granular data from the Dutch Data Warehouse

Author

Fleuren, Lucas M., Tonutti, Michele, de Bruin, Daan P., Lalisang, Robbert C. A., Dam, Tariq A., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Vonk, Sebastiaan J. J., Fornasa, Mattia, Machado, Tomas, van der Meer, Nardo J. M., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco, Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert, Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Achterberg, Sefanja, Faber, Harald J., Karakus, A., Beukema, Menno, Entjes, Robert, de Jong, Paul, Houwert, Taco, Hovenkamp, Hidde, Noorduijn Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G., de Beer, Aletta A., Cinà, Giovanni, Beudel, Martijn, de Keizer, Nicolet F., Hoogendoorn, Mark, Girbes, Armand R. J., Herter, Willem E., Elbers, Paul W. G., and Thoral, Patrick J.

Abstract

Additional file 1: Figure S1. Patient selection. Figure S2. Selection of observations throughout the course of IMV. Figure S3. Nested cross-validation. Figure S4. Importance of the top 10 predictors for the prediction of ventilator free days, as well as the difference for predictors over time. Figure S5. SHAP plot ICU mortality (XGBoost). Figure S6. SHAP plot for ICU free days (XGBoost). Figure S7. SHAP plot for ventilator free days (XGBoost). Figure S8. PDPs. Table S1. Overview of all predictors used in the model with a definition where applicable. Table S2. Overall algorithm performance for each of the different outcomes. Table S3. Statistical results for a regression model per outcome. Table S4. Predictor correlations.

Published
2021
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10. Additional file 3 of The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients

Author

Fleuren, Lucas M., Dam, Tariq A., Tonutti, Michele, de Bruin, Daan P., Lalisang, Robbert C. A., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco, Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Fornasa, Mattia, Machado, Tomas, Houwert, Taco, Hovenkamp, Hidde, Noorduijn-Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G., de Beer, Aletta A., Cina, Giovanni, Beudel, Martijn, Herter, Willem E., Girbes, Armand R. J., Hoogendoorn, Mark, Thoral, Patrick J., and Elbers, Paul W. G.

Abstract

Additional file 3: Table S1. Overview of derived clinical score.

Published
2021
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11. Additional file 1 of Predictors for extubation failure in COVID-19 patients using a machine learning approach

Author

Fleuren, Lucas M., Dam, Tariq A., Tonutti, Michele, de Bruin, Daan P., Lalisang, Robbert C. A., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco, Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Fornasa, Mattia, Machado, Tomas, Houwert, Taco, Hovenkamp, Hidde, Noorduijn Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G., de Beer, Aletta A., Cin��, Giovanni, Kantorik, Adam, de Ruijter, Tom, Herter, Willem E., Beudel, Martijn, Girbes, Armand R. J., Hoogendoorn, Mark, Thoral, Patrick J., and Elbers, Paul W. G.

Abstract

Additional file 1. Table S1 Overview of machine learning studies that investigate extubation readiness. Table S2 Model performance. Figure S1 PD-plot for BMI

Published
2021
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12. Additional file 2 of The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients

Author

Fleuren, Lucas M., Dam, Tariq A., Tonutti, Michele, de Bruin, Daan P., Lalisang, Robbert C. A., Gommers, Diederik, Cremer, Olaf L., Bosman, Rob J., Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A., de Jong, Remko, Peters, Marco, Kamps, Marlijn J. A., Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G. C. A., de Ruijter, Wouter, Urlings-Strop, Louise C., Smit, Ellen G. M., Mehagnoul-Schipper, D. Jannet, Dormans, Tom, de Jager, Cornelis P. C., Hendriks, Stefaan H. A., Achterberg, Sefanja, Oostdijk, Evelien, Reidinga, Auke C., Festen-Spanjer, Barbara, Brunnekreef, Gert B., Cornet, Alexander D., van den Tempel, Walter, Boelens, Age D., Koetsier, Peter, Lens, Judith, Faber, Harald J., Karakus, A., Entjes, Robert, de Jong, Paul, Rettig, Thijs C. D., Arbous, Sesmu, Vonk, Sebastiaan J. J., Fornasa, Mattia, Machado, Tomas, Houwert, Taco, Hovenkamp, Hidde, Noorduijn-Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G., de Beer, Aletta A., Cina, Giovanni, Beudel, Martijn, Herter, Willem E., Girbes, Armand R. J., Hoogendoorn, Mark, Thoral, Patrick J., and Elbers, Paul W. G.

Subjects
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Data_FILES
Abstract

Additional file 2. Institutional review board documentation.

Published
2021
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13. Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome

Author

Dam, Tariq A, Dam, Tariq A, de Grooth, Harm-Jan, Klausch, Thomas, Fleuren, Lucas M, de Bruin, Daan P, Entjes, Robert, Rettig, Thijs C D, Dongelmans, Dave A, Boelens, Age D, Rigter, Sander, Hendriks, Stefaan H A, de Jong, Remko, Kamps, Marlijn J A, Peters, Marco, Karakus, A, Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P C, Nooteboom, Fleur G C A, Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D, Reidinga, Auke C, de Ruijter, Wouter, Bosman, Rob J, Frenzel, Tim, Urlings-Strop, Louise C, de Jong, Paul, Smit, Ellen G M, Cremer, Olaf L, Mehagnoul-Schipper, D Jannet, Faber, Harald J, Lens, Judith, Brunnekreef, Gert B, Festen-Spanjer, Barbara, Dormans, Tom, Dijkstra, Annemieke, Simons, Bram, Rijkeboer, A A, Arbous, Sesmu, Aries, Marcel, Beukema, Menno, Pretorius, Daniël, van Raalte, Rutger, van Tellingen, Martijn, Gritters van den Oever, Niels C, Lalisang, Robbert C A, Tonutti, Michele, Girbes, Armand R J, Hoogendoorn, Mark, Thoral, Patrick J, Elbers, Paul W G, Dam, Tariq A, Dam, Tariq A, de Grooth, Harm-Jan, Klausch, Thomas, Fleuren, Lucas M, de Bruin, Daan P, Entjes, Robert, Rettig, Thijs C D, Dongelmans, Dave A, Boelens, Age D, Rigter, Sander, Hendriks, Stefaan H A, de Jong, Remko, Kamps, Marlijn J A, Peters, Marco, Karakus, A, Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P C, Nooteboom, Fleur G C A, Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D, Reidinga, Auke C, de Ruijter, Wouter, Bosman, Rob J, Frenzel, Tim, Urlings-Strop, Louise C, de Jong, Paul, Smit, Ellen G M, Cremer, Olaf L, Mehagnoul-Schipper, D Jannet, Faber, Harald J, Lens, Judith, Brunnekreef, Gert B, Festen-Spanjer, Barbara, Dormans, Tom, Dijkstra, Annemieke, Simons, Bram, Rijkeboer, A A, Arbous, Sesmu, Aries, Marcel, Beukema, Menno, Pretorius, Daniël, van Raalte, Rutger, van Tellingen, Martijn, Gritters van den Oever, Niels C, Lalisang, Robbert C A, Tonutti, Michele, Girbes, Armand R J, Hoogendoorn, Mark, Thoral, Patrick J, and Elbers, Paul W G

Abstract

OBJECTIVES: As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients.DESIGN: Multicenter retrospective cohort study.SETTING: Twenty-five hospitals in the Netherlands from February 2020 to July 2020, and 14 hospitals from August 2020 to December 2020.PATIENTS: One thousand two hundred ninety-four critically ill intubated adult ICU patients with coronavirus disease 2019 were selected from the Dutch Data Warehouse. Patients intubated for less than 24 hours, transferred patients, and patients still admitted at the time of data extraction were excluded.MEASUREMENTS AND MAIN RESULTS: We aimed to estimate between-ICU practice variation in selected ventilation parameters (positive end-expiratory pressure, Fio2, set respiratory rate, tidal volume, minute volume, and percentage of time spent in a prone position) on days 1, 2, 3, and 7 of intubation, adjusted for patient characteristics as well as severity of illness based on Pao2/Fio2 ratio, pH, ventilatory ratio, and dynamic respiratory system compliance during controlled ventilation. Using multilevel linear mixed-effects modeling, we found significant (p ≤ 0.001) variation between ICUs in all ventilation parameters on days 1, 2, 3, and 7 of intubation for both waves.CONCLUSIONS: This is the first study to clearly demonstrate significant practice variation between ICUs related to mechanical ventilation parameters that are under dire

Published
2021

14. Risk factors for adverse outcomes during mechanical ventilation of 1152 COVID-19 patients:a multicenter machine learning study with highly granular data from the Dutch Data Warehouse

Author

Fleuren, Lucas M, Tonutti, Michele, de Bruin, Daan P, Lalisang, Robbert C A, Dam, Tariq A, Gommers, Diederik, Cremer, Olaf L, Bosman, Rob J, Vonk, Sebastiaan J J, Fornasa, Mattia, Machado, Tomas, van der Meer, Nardo J M, Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A, de Jong, Remko, Peters, Marco, Kamps, Marlijn J A, Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G C A, de Ruijter, Wouter, Urlings-Strop, Louise C, Smit, Ellen G M, Mehagnoul-Schipper, D Jannet, Dormans, Tom, de Jager, Cornelis P C, Hendriks, Stefaan H A, Oostdijk, Evelien, Reidinga, Auke C, Festen-Spanjer, Barbara, Brunnekreef, Gert, Cornet, Alexander D, van den Tempel, Walter, Boelens, Age D, Koetsier, Peter, Lens, Judith, Achterberg, Sefanja, Faber, Harald J, Karakus, A, Beukema, Menno, Entjes, Robert, de Jong, Paul, Houwert, Taco, Hovenkamp, Hidde, Noorduijn Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G, de Beer, Aletta A, Fleuren, Lucas M, Tonutti, Michele, de Bruin, Daan P, Lalisang, Robbert C A, Dam, Tariq A, Gommers, Diederik, Cremer, Olaf L, Bosman, Rob J, Vonk, Sebastiaan J J, Fornasa, Mattia, Machado, Tomas, van der Meer, Nardo J M, Rigter, Sander, Wils, Evert-Jan, Frenzel, Tim, Dongelmans, Dave A, de Jong, Remko, Peters, Marco, Kamps, Marlijn J A, Ramnarain, Dharmanand, Nowitzky, Ralph, Nooteboom, Fleur G C A, de Ruijter, Wouter, Urlings-Strop, Louise C, Smit, Ellen G M, Mehagnoul-Schipper, D Jannet, Dormans, Tom, de Jager, Cornelis P C, Hendriks, Stefaan H A, Oostdijk, Evelien, Reidinga, Auke C, Festen-Spanjer, Barbara, Brunnekreef, Gert, Cornet, Alexander D, van den Tempel, Walter, Boelens, Age D, Koetsier, Peter, Lens, Judith, Achterberg, Sefanja, Faber, Harald J, Karakus, A, Beukema, Menno, Entjes, Robert, de Jong, Paul, Houwert, Taco, Hovenkamp, Hidde, Noorduijn Londono, Roberto, Quintarelli, Davide, Scholtemeijer, Martijn G, and de Beer, Aletta A

Abstract

BACKGROUND: The identification of risk factors for adverse outcomes and prolonged intensive care unit (ICU) stay in COVID-19 patients is essential for prognostication, determining treatment intensity, and resource allocation. Previous studies have determined risk factors on admission only, and included a limited number of predictors. Therefore, using data from the highly granular and multicenter Dutch Data Warehouse, we developed machine learning models to identify risk factors for ICU mortality, ventilator-free days and ICU-free days during the course of invasive mechanical ventilation (IMV) in COVID-19 patients.METHODS: The DDW is a growing electronic health record database of critically ill COVID-19 patients in the Netherlands. All adult ICU patients on IMV were eligible for inclusion. Transfers, patients admitted for less than 24 h, and patients still admitted at time of data extraction were excluded. Predictors were selected based on the literature, and included medication dosage and fluid balance. Multiple algorithms were trained and validated on up to three sets of observations per patient on day 1, 7, and 14 using fivefold nested cross-validation, keeping observations from an individual patient in the same split.RESULTS: A total of 1152 patients were included in the model. XGBoost models performed best for all outcomes and were used to calculate predictor importance. Using Shapley additive explanations (SHAP), age was the most important demographic risk factor for the outcomes upon start of IMV and throughout its course. The relative probability of death across age values is visualized in Partial Dependence Plots (PDPs), with an increase starting at 54 years. Besides age, acidaemia, low P/F-ratios and high driving pressures demonstrated a higher probability of death. The PDP for driving pressure showed a relative probability increase starting at 12 cmH2O.CONCLUSION: Age is the most important demographic risk factor of ICU mortality, I

Published
2021

15. Some Patients Are More Equal Than Others:Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome

Author

Dam, Tariq A, de Grooth, Harm-Jan, Klausch, Thomas, Fleuren, Lucas M, de Bruin, Daan P, Entjes, Robert, Rettig, Thijs C D, Dongelmans, Dave A, Boelens, Age D, Rigter, Sander, Hendriks, Stefaan H A, de Jong, Remko, Kamps, Marlijn J A, Peters, Marco, Karakus, A, Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P C, Nooteboom, Fleur G C A, Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D, Reidinga, Auke C, de Ruijter, Wouter, Bosman, Rob J, Frenzel, Tim, Urlings-Strop, Louise C, de Jong, Paul, Smit, Ellen G M, Cremer, Olaf L, Mehagnoul-Schipper, D Jannet, Faber, Harald J, Lens, Judith, Brunnekreef, Gert B, Festen-Spanjer, Barbara, Dormans, Tom, Dijkstra, Annemieke, Simons, Bram, Rijkeboer, A A, Arbous, Sesmu, Aries, Marcel, Beukema, Menno, Pretorius, Daniël, van Raalte, Rutger, van Tellingen, Martijn, Gritters van den Oever, Niels C, Lalisang, Robbert C A, Tonutti, Michele, Girbes, Armand R J, Hoogendoorn, Mark, Thoral, Patrick J, Elbers, Paul W G, Dam, Tariq A, de Grooth, Harm-Jan, Klausch, Thomas, Fleuren, Lucas M, de Bruin, Daan P, Entjes, Robert, Rettig, Thijs C D, Dongelmans, Dave A, Boelens, Age D, Rigter, Sander, Hendriks, Stefaan H A, de Jong, Remko, Kamps, Marlijn J A, Peters, Marco, Karakus, A, Gommers, Diederik, Ramnarain, Dharmanand, Wils, Evert-Jan, Achterberg, Sefanja, Nowitzky, Ralph, van den Tempel, Walter, de Jager, Cornelis P C, Nooteboom, Fleur G C A, Oostdijk, Evelien, Koetsier, Peter, Cornet, Alexander D, Reidinga, Auke C, de Ruijter, Wouter, Bosman, Rob J, Frenzel, Tim, Urlings-Strop, Louise C, de Jong, Paul, Smit, Ellen G M, Cremer, Olaf L, Mehagnoul-Schipper, D Jannet, Faber, Harald J, Lens, Judith, Brunnekreef, Gert B, Festen-Spanjer, Barbara, Dormans, Tom, Dijkstra, Annemieke, Simons, Bram, Rijkeboer, A A, Arbous, Sesmu, Aries, Marcel, Beukema, Menno, Pretorius, Daniël, van Raalte, Rutger, van Tellingen, Martijn, Gritters van den Oever, Niels C, Lalisang, Robbert C A, Tonutti, Michele, Girbes, Armand R J, Hoogendoorn, Mark, Thoral, Patrick J, and Elbers, Paul W G

Abstract

OBJECTIVES: As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients.DESIGN: Multicenter retrospective cohort study.SETTING: Twenty-five hospitals in the Netherlands from February 2020 to July 2020, and 14 hospitals from August 2020 to December 2020.PATIENTS: One thousand two hundred ninety-four critically ill intubated adult ICU patients with coronavirus disease 2019 were selected from the Dutch Data Warehouse. Patients intubated for less than 24 hours, transferred patients, and patients still admitted at the time of data extraction were excluded.MEASUREMENTS AND MAIN RESULTS: We aimed to estimate between-ICU practice variation in selected ventilation parameters (positive end-expiratory pressure, Fio2, set respiratory rate, tidal volume, minute volume, and percentage of time spent in a prone position) on days 1, 2, 3, and 7 of intubation, adjusted for patient characteristics as well as severity of illness based on Pao2/Fio2 ratio, pH, ventilatory ratio, and dynamic respiratory system compliance during controlled ventilation. Using multilevel linear mixed-effects modeling, we found significant (p ≤ 0.001) variation between ICUs in all ventilation parameters on days 1, 2, 3, and 7 of intubation for both waves.CONCLUSIONS: This is the first study to clearly demonstrate significant practice variation between ICUs related to mechanical ventilation parameters that are under dire

Published
2021

17. INCIDENCE, RISK FACTORS, AND OUTCOME OF SUSPECTED CENTRAL VENOUS CATHETER-RELATED INFECTIONS IN CRITICALLY ILL COVID-19 PATIENTS: A MULTICENTER RETROSPECTIVE COHORT STUDY.

Author

Smit JM, Exterkate L, van Tienhoven AJ, Haaksma ME, Heldeweg MLA, Fleuren L, Thoral P, Dam TA, Heunks LMA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Vlaar AP, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk B, Machado T, Girbes ARJ, Sieswerda E, Elbers PWG, and Tuinman PR

Subjects
Humans, Critical Illness, Incidence, Retrospective Studies, Risk Factors, Catheter-Related Infections epidemiology, Catheter-Related Infections etiology, Catheterization, Central Venous adverse effects, COVID-19 epidemiology, Central Venous Catheters adverse effects
Abstract

Abstract: Background: Aims of this study were to investigate the prevalence and incidence of catheter-related infection, identify risk factors, and determine the relation of catheter-related infection with mortality in critically ill COVID-19 patients. Methods: This was a retrospective cohort study of central venous catheters (CVCs) in critically ill COVID-19 patients. Eligible CVC insertions required an indwelling time of at least 48 hours and were identified using a full-admission electronic health record database. Risk factors were identified using logistic regression. Differences in survival rates at day 28 of follow-up were assessed using a log-rank test and proportional hazard model. Results: In 538 patients, a total of 914 CVCs were included. Prevalence and incidence of suspected catheter-related infection were 7.9% and 9.4 infections per 1,000 catheter indwelling days, respectively. Prone ventilation for more than 5 days was associated with increased risk of suspected catheter-related infection; odds ratio, 5.05 (95% confidence interval 2.12-11.0). Risk of death was significantly higher in patients with suspected catheter-related infection (hazard ratio, 1.78; 95% confidence interval, 1.25-2.53). Conclusions: This study shows that in critically ill patients with COVID-19, prevalence and incidence of suspected catheter-related infection are high, prone ventilation is a risk factor, and mortality is higher in case of catheter-related infection., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by the Shock Society.)

Published
2022
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18. Assess and validate predictive performance of models for in-hospital mortality in COVID-19 patients: A retrospective cohort study in the Netherlands comparing the value of registry data with high-granular electronic health records.

Author

Vagliano I, Schut MC, Abu-Hanna A, Dongelmans DA, de Lange DW, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, de Jong R, Peters MAA, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Reuland MC, Arbous S, Fleuren LM, Dam TA, Thoral PJ, Lalisang RCA, Tonutti M, de Bruin DP, Elbers PWG, and de Keizer NF

Subjects
Electronic Health Records, Hospital Mortality, Humans, Intensive Care Units, Netherlands epidemiology, Registries, Retrospective Studies, COVID-19 epidemiology
Abstract

Purpose: To assess, validate and compare the predictive performance of models for in-hospital mortality of COVID-19 patients admitted to the intensive care unit (ICU) over two different waves of infections. Our models were built with high-granular Electronic Health Records (EHR) data versus less-granular registry data., Methods: Observational study of all COVID-19 patients admitted to 19 Dutch ICUs participating in both the national quality registry National Intensive Care Evaluation (NICE) and the EHR-based Dutch Data Warehouse (hereafter EHR). Multiple models were developed on data from the first 24 h of ICU admissions from February to June 2020 (first COVID-19 wave) and validated on prospective patients admitted to the same ICUs between July and December 2020 (second COVID-19 wave). We assessed model discrimination, calibration, and the degree of relatedness between development and validation population. Coefficients were used to identify relevant risk factors., Results: A total of 1533 patients from the EHR and 1563 from the registry were included. With high granular EHR data, the average AUROC was 0.69 (standard deviation of 0.05) for the internal validation, and the AUROC was 0.75 for the temporal validation. The registry model achieved an average AUROC of 0.76 (standard deviation of 0.05) in the internal validation and 0.77 in the temporal validation. In the EHR data, age, and respiratory-system related variables were the most important risk factors identified. In the NICE registry data, age and chronic respiratory insufficiency were the most important risk factors., Conclusion: In our study, prognostic models built on less-granular but readily-available registry data had similar performance to models built on high-granular EHR data and showed similar transportability to a prospective COVID-19 population. Future research is needed to verify whether this finding can be confirmed for upcoming waves., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2022
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19. Rapid Evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in-hospital mortality.

Author

Plečko D, Bennett N, Mårtensson J, Dam TA, Entjes R, Rettig TCD, Dongelmans DA, Boelens AD, Rigter S, Hendriks SHA, de Jong R, Kamps MJA, Peters M, Karakus A, Gommers D, Ramnarain D, Wils EJ, Achterberg S, Nowitzky R, van den Tempel W, de Jager CPC, Nooteboom FGCA, Oostdijk E, Koetsier P, Cornet AD, Reidinga AC, de Ruijter W, Bosman RJ, Frenzel T, Urlings-Strop LC, de Jong P, Smit EGM, Cremer OL, Mehagnoul-Schipper DJ, Faber HJ, Lens J, Brunnekreef GB, Festen-Spanjer B, Dormans T, de Bruin DP, Lalisang RCA, Vonk SJJ, Haan ME, Fleuren LM, Thoral PJ, Elbers PWG, and Bellomo R

Subjects
Adult, Aged, Critical Care, Hospital Mortality, Humans, Intensive Care Units, Male, Multicenter Studies as Topic, Observational Studies as Topic, Patient Acuity, Prognosis, Retrospective Studies, SARS-CoV-2, COVID-19
Abstract

Background: The prediction of in-hospital mortality for ICU patients with COVID-19 is fundamental to treatment and resource allocation. The main purpose was to develop an easily implemented score for such prediction., Methods: This was an observational, multicenter, development, and validation study on a national critical care dataset of COVID-19 patients. A systematic literature review was performed to determine variables possibly important for COVID-19 mortality prediction. Using a logistic multivariable model with a LASSO penalty, we developed the Rapid Evaluation of Coronavirus Illness Severity (RECOILS) score and compared its performance against published scores., Results: Our development (validation) cohort consisted of 1480 (937) adult patients from 14 (11) Dutch ICUs admitted between March 2020 and April 2021. Median age was 65 (65) years, 31% (26%) died in hospital, 74% (72%) were males, average length of ICU stay was 7.83 (10.25) days and average length of hospital stay was 15.90 (19.92) days. Age, platelets, PaO2/FiO2 ratio, pH, blood urea nitrogen, temperature, PaCO2, Glasgow Coma Scale (GCS) score measured within +/-24 h of ICU admission were used to develop the score. The AUROC of RECOILS score was 0.75 (CI 0.71-0.78) which was higher than that of any previously reported predictive scores (0.68 [CI 0.64-0.71], 0.61 [CI 0.58-0.66], 0.67 [CI 0.63-0.70], 0.70 [CI 0.67-0.74] for ISARIC 4C Mortality Score, SOFA, SAPS-III, and age, respectively)., Conclusions: Using a large dataset from multiple Dutch ICUs, we developed a predictive score for mortality of COVID-19 patients admitted to ICU, which outperformed other predictive scores reported so far., (© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Published
2022
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20. Risk factors for adverse outcomes during mechanical ventilation of 1152 COVID-19 patients: a multicenter machine learning study with highly granular data from the Dutch Data Warehouse.

Author

Fleuren LM, Tonutti M, de Bruin DP, Lalisang RCA, Dam TA, Gommers D, Cremer OL, Bosman RJ, Vonk SJJ, Fornasa M, Machado T, van der Meer NJM, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef G, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Achterberg S, Faber HJ, Karakus A, Beukema M, Entjes R, de Jong P, Houwert T, Hovenkamp H, Noorduijn Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cinà G, Beudel M, de Keizer NF, Hoogendoorn M, Girbes ARJ, Herter WE, Elbers PWG, and Thoral PJ

Abstract

Background: The identification of risk factors for adverse outcomes and prolonged intensive care unit (ICU) stay in COVID-19 patients is essential for prognostication, determining treatment intensity, and resource allocation. Previous studies have determined risk factors on admission only, and included a limited number of predictors. Therefore, using data from the highly granular and multicenter Dutch Data Warehouse, we developed machine learning models to identify risk factors for ICU mortality, ventilator-free days and ICU-free days during the course of invasive mechanical ventilation (IMV) in COVID-19 patients., Methods: The DDW is a growing electronic health record database of critically ill COVID-19 patients in the Netherlands. All adult ICU patients on IMV were eligible for inclusion. Transfers, patients admitted for less than 24 h, and patients still admitted at time of data extraction were excluded. Predictors were selected based on the literature, and included medication dosage and fluid balance. Multiple algorithms were trained and validated on up to three sets of observations per patient on day 1, 7, and 14 using fivefold nested cross-validation, keeping observations from an individual patient in the same split., Results: A total of 1152 patients were included in the model. XGBoost models performed best for all outcomes and were used to calculate predictor importance. Using Shapley additive explanations (SHAP), age was the most important demographic risk factor for the outcomes upon start of IMV and throughout its course. The relative probability of death across age values is visualized in Partial Dependence Plots (PDPs), with an increase starting at 54 years. Besides age, acidaemia, low P/F-ratios and high driving pressures demonstrated a higher probability of death. The PDP for driving pressure showed a relative probability increase starting at 12 cmH 2 O., Conclusion: Age is the most important demographic risk factor of ICU mortality, ICU-free days and ventilator-free days throughout the course of invasive mechanical ventilation in critically ill COVID-19 patients. pH, P/F ratio, and driving pressure should be monitored closely over the course of mechanical ventilation as risk factors predictive of these outcomes.

Published
2021
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