Applicability of an unsupervised cluster model developed on first wave COVID-19 patients in second/third wave critically ill patients

Objective

To validate the unsupervised cluster model (USCM) developed during the first pandemic wave in a cohort of critically ill patients from the second and third pandemic waves.

Design

Observational, retrospective, multicentre study.

Setting

Intensive Care Unit (ICU).

Patients

Adult patients admitted with COVID-19 and respiratory failure during the second and third pandemic waves.

Interventions

None.

Main variables of interest

Collected data included demographic and clinical characteristics, comorbidities, laboratory tests and ICU outcomes. To validate our original USCM, we assigned a phenotype to each patient of the validation cohort. The performance of the classification was determined by Silhouette coefficient (SC) and general linear modelling. In a post-hoc analysis we developed and validated a USCM specific to the validation set. The model’s performance was measured using accuracy test and area under curve (AUC) ROC.

Results

A total of 2330 patients (mean age 63 [53–82] years, 1643 (70.5%) male, median APACHE II score (12 [9–16]) and SOFA score (4 [3–6]) were included. The ICU mortality was 27.2%. The USCM classified patients into 3 clinical phenotypes: A (n = 1206 patients, 51.8%); B (n = 618 patients, 26.5%), and C (n = 506 patients, 21.7%). The characteristics of patients within each phenotype were significantly different from the original population. The SC was −0.007 and the inclusion of phenotype classification in a regression model did not improve the model performance (0.79 and 0.78 ROC for original and validation model). The post-hoc model performed better than the validation model (SC −0.08).

Conclusion

Models developed using machine learning techniques during the first pandemic wave cannot be applied with adequate performance to patients admitted in subsequent waves without prior validation.