AUTHOR=Moorman Nina , Hedlund-Botti Erin , Gombolay Grace , Gombolay Matthew C. 
  
TITLE=Use of machine learning models to predict mechanical ventilation, ECMO, and mortality in COVID-19
  
JOURNAL=Frontiers in Artificial Intelligence
  
VOLUME=Volume 8 - 2025
  
YEAR=2026
  
URL=https://www.frontiersin.org/journals/artificial-intelligence/articles/10.3389/frai.2025.1661637
  
DOI=10.3389/frai.2025.1661637
  
ISSN=2624-8212
  
ABSTRACT=IntroductionPatients with severe COVID-19 may require MV or ECMO. Predicting who will require interventions and the duration of those interventions are challenging due to the diverse responses among patients and the dynamic nature of the disease. As such, there is a need for better prediction of the duration and outcomes of MV use in patients, to improve patient care and aid with MV and ECMO allocation. Here we develop and examine the performance of ML models to predict MV duration, ECMO, and mortality for patients with COVID-19.MethodsIn this retrospective prognostic study, hierarchical machine-learning models were developed to predict MV duration and outcome prediction from demographic data and time-series data consisting of vital signs and laboratory results. We train our models on 10,378 patients with positive severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) virus testing from Emory’s COVID CRADLE Dataset who sought treatment at Emory University Hospital between February 28, 2020, to January 24, 2022. Analysis was conducted between January 10, 2022, and April 5, 2024. The main outcomes and measures were the AUROC, AUPRC and the F-score for MV duration, need for ECMO, and mortality prediction.ResultsData from 10,378 patients with COVID-19 (median [IQR] age, 60 [48–72] years; 5,281 [50.89%] women) were included. Overall MV class distributions for 0 days, 1–4 days, 5–9 days, 10–14 days, 15–19 days, 20–24 days, 25–29 days, and ≥30 days of MV were 8,141 (78.44%), 812 (7.82%), 325 (3.13%), 241 (2.32%), 153 (1.47%), 97 (0.93%), 87 (0.84%), and 522 (5.03%), respectively. Overall ECMO use and mortality rates were 15 (0.14%) and 1,114 (10.73%), respectively. On MV duration, ECMO use, and mortality outcomes, the highest-performing model reached weighted average AUROC scores of 0.873, 0.902, and 0.774, and the highest-performing model reached weighted average AUPRC scores of 0.790, 0.999, and 0.893.Conclusions and relevanceHierarchical ML models trained on vital signs, laboratory results, and demographic data show promise for the prediction of MV duration, ECMO use, and mortality in COVID-19 patients.