Effectiveness, Explainability and Reliability of Machine Meta-Learning Methods for Predicting Mortality in Patients with COVID-19: Results of the Brazilian COVID-19 Registry

Objective: To provide a thorough comparative study among state ofthe art machine learning methods and statistical methods for determining in-hospital mortality in COVID 19 patients using data upon hospital admission; to study the reliability of the predictions of the most effective methods by correlating the probability of the outcome and the accuracy of the methods; to investigate how explainable are the predictions produced by the most effective methods. Materials and Methods: De-identified data were obtained from COVID 19 positive patients in 36 participating hospitals, from March 1 to September 30, 2020. Demographic, comorbidity, clinical presentation and laboratory data were used as training data to develop COVID 19 mortality prediction models. Multiple machine learning and traditional statistics models were trained on this prediction task using a folded cross validation procedure, from which we assessed performance and interpretability metrics. Results: The Stacking of machine learning models improved over the previous state of the art results by more than 26% in predicting the class of interest (death), achieving 87.1% of AUROC and macroF1 of 73.9%. We also show that some machine learning models can be very interpretable and reliable, yielding more accurate predictions while providing a good explanation for the why. Conclusion: The best results were obtained using the meta learning ensemble model Stacking. State of the art explainability techniques such as SHAP values can be used to draw useful insights into the patterns learned by machine-learning algorithms. Machine learning models can be more explainable than traditional statistics models while also yielding highly reliable predictions. Key words: COVID-19; prognosis; prediction model; machine learning