A machine learning explanation of the pathogen-immune relationship of SARS-CoV-2 and machine learning models of prognostic biomarkers to predict asymptomatic or symptomatic infections

Structured AbstractO_ST_ABSImportanceC_ST_ABSThe clinical impacts of this study are it: (1) identified three immunological factors that differentiate asymptomatic, or resistant, COVID-19 patients; (2) identified the levels of those factors that can be used by clinicians to predict who is likely to be asymptomatic or symptomatic; (3) identified a novel COVID-19 therapeutic for further testing; and, (4) ordinally ranked 34 common immunological factors by their importance in predicting disease severity. ObjectivesThe primary objectives of this study were to learn if machine learning could identify patterns in the pathogen-host immune relationship that differentiate or predict COVID-19 symptom immunity and, if so, which ones and at what levels. The secondary objective was to learn if machine learning could take such differentiators to build a model that could predict COVID-19 immunity with clinical accuracy. The tertiary objective was to learn about the relevance of other immune factors. DesignThis was a comparative effectiveness research study on 53 common immunological factors using machine learning on clinical data from 74 similarly-grouped Chinese COVID-19-positive patients, 37 of whom were symptomatic and 37 asymptomatic. SettingA single-center primary-care hospital in the Wanzhou District of China. ParticipantsImmunological factors were measured in patients who were diagnosed as SARS-CoV-2 positive by reverse transcriptase-polymerase chain reaction (RT-PCR) in the 14 days before the recordation of the observations. The median age of the 37 asymptomatic patients was 41 years (range 8-75 years), 22 were female, 15 were male. For comparison, 37 RT-PCR test-positive patients were selected and matched to the asymptomatic group by age, comorbidities, and sex. Main OutcomeThe primary study outcome was that asymptomatic COVID-19 patients could be identified by three distinct immunological factors and level: stem-cell growth factor-beta (SCGF-{beta}) (> 127637), interleukin-16 (IL-16) (> 45), and macrophage colony-stimulating factor (M-CSF) (> 57). The secondary study outcome was the novel suggestion that stem-cell therapy with SCGF-{beta} may be a new valuable therapeutic for COVID-19. ResultsWhen SCGF-{beta} was included in the machine-learning analysis, a decision-tree and extreme gradient boosting algorithms classified and predicted COVID-19 symptoms immunity with 100% accuracy. When SCGF-{beta} was excluded, a random-forest algorithm classified and predicted COVID-19 asymptomatic and symptomatic cases with 94.8% area under the ROC curve accuracy (95% CI 90.17% to 100%). Thirty-four (34) common immune factors have statistically significant (P-value < .05) associations with COVID-19 symptoms and 19 immune factors appear to have no statistically significant association. ConclusionPeople with an SCGF-{beta} level > 127637, or an IL-16 level > 45 and M-CSF level > 57, appear to be predictively immune to COVID-19, 100% and 94.8% (ROC AUC) of the time, respectively. Testing levels of these three immunological factors may be a valuable tool at the point-of-care for managing and preventing outbreaks. Further, stem-cell therapy via SCGF-{beta} and/or M-CSF appear to be promising novel therapeutics for COVID-19.