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Detecting the most critical clinical variables of COVID-19 breakthrough infection in vaccinated persons using machine learning

Daramola et al., DIGITAL HEALTH, doi:10.1177/20552076231207593
Nov 2023  
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Retrospective 257 individuals, finding higher physical activity as one of the most predictive variables for lower risk of COVID-19 breakthrough infection.
Daramola et al., 5 Nov 2023, South Africa, peer-reviewed, 14 authors, study period 14 April, 2021 - 3 July, 2021.
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Detecting the most critical clinical variables of COVID-19 breakthrough infection in vaccinated persons using machine learning
Olawande Daramola, Tatenda Duncan Kavu, Maritha J Kotze, Oiva Kamati, Zaakiyah Emjedi, Boniface Kabaso, Thomas Moser, Karl Stroetmann, Isaac Fwemba, Fisayo Daramola, Martha Nyirenda, Susan J Van Rensburg, Peter S Nyasulu, Jeanine L Marnewick
DIGITAL HEALTH, doi:10.1177/20552076231207593
Background: COVID-19 vaccines offer different levels of immune protection but do not provide 100% protection. Vaccinated persons with pre-existing comorbidities may be at an increased risk of SARS-CoV-2 breakthrough infection or reinfection. The aim of this study is to identify the critical variables associated with a higher probability of SARS-CoV-2 breakthrough infection using machine learning. Methods: A dataset comprising symptoms and feedback from 257 persons, of whom 203 were vaccinated and 54 unvaccinated, was used for the investigation. Three machine learning algorithms -Deep Multilayer Perceptron (Deep MLP), XGBoost, and Logistic Regressionwere trained with the original (imbalanced) dataset and the balanced dataset created by using the Random Oversampling Technique (ROT), and the Synthetic Minority Oversampling Technique (SMOTE). We compared the performance of the classification algorithms when the features highly correlated with breakthrough infection were used and when all features in the dataset were used. Result: The results show that when highly correlated features were considered as predictors, with Random Oversampling to address data imbalance, the XGBoost classifier has the best performance (F1 = 0.96; accuracy = 0.96; AUC = 0.98; G-Mean = 0.98; MCC = 0.88). The Deep MLP had the second best performance (F1 = 0.94; accuracy = 0.94; AUC = 0.92; G-Mean = 0.70; MCC = 0.42), while Logistic Regression had less accurate performance (F1 = 0.89; accuracy = 0.88; AUC = 0.89; G-Mean = 0.89; MCC = 0.68). We also used Shapley Additive Explanations (SHAP) to investigate the interpretability of the models. We found that body temperature, total cholesterol, glucose level, blood pressure, waist circumference, body weight, body mass index (BMI), haemoglobin level, and physical activity per week are the most critical variables indicating a higher risk of breakthrough infection. Conclusion: These results, evident from our unique data source derived from apparently healthy volunteers with cardiovascular risk factors, follow the expected pattern of positive or negative correlations previously reported in the literature. This information strengthens the body of knowledge currently applied in public health guidelines and may also be used by medical practitioners in the future to reduce the risk of SARS-CoV-2 breakthrough infection.
complications from SARS-CoV-2. Woods et al. 25 opined that the immobilisation and the physical inactivity of patients could down-regulate the ability of organ systems to resist viral infection and increase the risk of damage to the immune, respiratory, cardiovascular, and musculoskeletal systems and the brain. Shahidi et al. 42 concurred with Woods et al. 25 by reporting that physical activity benefits include musculoskeletal and cardiovascular health, healthy
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