Machine Learning Models for Image-Based Diagnosis and Prognosis of COVID-19: Systematic Review

BACKGROUND: Accurate and timely diagnosis and effective prognosis of the disease is important to provide the best possible care for patients with COVID-19 and reduce the burden on the health care system. Machine learning methods can play a vital role in the diagnosis of COVID-19 by processing chest x-ray images. OBJECTIVE: The aim of this study is to summarize information on the use of intelligent models for the diagnosis and prognosis of COVID-19 to help with early and timely diagnosis, minimize prolonged diagnosis, and improve overall health care. METHODS: A systematic search of databases, including PubMed, Web of Science, IEEE, ProQuest, Scopus, bioRxiv, and medRxiv, was performed for COVID-19–related studies published up to May 24, 2020. This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. All original research articles describing the application of image processing for the prediction and diagnosis of COVID-19 were considered in the analysis. Two reviewers independently assessed the published papers to determine eligibility for inclusion in the analysis. Risk of bias was evaluated using the Prediction Model Risk of Bias Assessment Tool. RESULTS: Of the 629 articles retrieved, 44 articles were included. We identified 4 prognosis models for calculating prediction of disease severity and estimation of confinement time for individual patients, and 40 diagnostic models for detecting COVID-19 from normal or other pneumonias. Most included studies used deep learning methods based on convolutional neural networks, which have been widely used as a classification algorithm. The most frequently reported predictors of prognosis in patients with COVID-19 included age, computed tomography data, gender, comorbidities, symptoms, and laboratory findings. Deep convolutional neural networks obtained better results compared with non–neural network–based methods. Moreover, all of the models were found to be at high risk of bias due to the lack of information about the study population, intended groups, and inappropriate reporting. CONCLUSIONS: Machine learning models used for the diagnosis and prognosis of COVID-19 showed excellent discriminative performance. However, these models were at high risk of bias, because of various reasons such as inadequate information about study participants, randomization process, and the lack of external validation, which may have resulted in the optimistic reporting of these models. Hence, our findings do not recommend any of the current models to be used in practice for the diagnosis and prognosis of COVID-19.