The COVIDTW study: Clinical predictors of COVID-19 mortality and a novel AI prognostic model using chest X-ray

Chih Wei Wu, Bach Tung Pham, Jia Ching Wang, Yao Kuang Wu, Chan Yen Kuo, Yi Chiung Hsu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: There is a lack of published research on the impact of the first wave of the COVID-19 pandemic in Taiwan. We investigated the mortality risk factors among critically ill patients with COVID-19 in Taiwan during the initial wave. Furthermore, we aim to develop a novel AI mortality prediction model using chest X-ray (CXR) alone. Method: We retrospectively reviewed the medical records of patients with COVID-19 at Taipei Tzu Chi Hospital from May 15 to July 15 2021. We enrolled adult patients who received invasive mechanical ventilation. The CXR images of each enrolled patient were divided into 4 categories (1st, pre-ETT, ETT, and WORST). To establish a prediction model, we used the MobilenetV3-Small model with “Imagenet” pretrained weights, followed by high Dropout regularization layers. We trained the model with these data with Five-Fold Cross-Validation to evaluate model performance. Result: A total of 64 patients were enrolled. The overall mortality rate was 45%. The median time from symptom onset to intubation was 8 days. Vasopressor use and a higher BRIXIA score on the WORST CXR were associated with an increased risk of mortality. The areas under the curve of the 1st, pre-ETT, ETT, and WORST CXRs by the AI model were 0.87, 0.92, 0.96, and 0.93 respectively. Conclusion: The mortality rate of COVID-19 patients who receive invasive mechanical ventilation was high. Septic shock and high BRIXIA score were clinical predictors of mortality. The novel AI mortality prediction model using CXR alone exhibited a high performance.

Original languageEnglish
Pages (from-to)267-275
Number of pages9
JournalJournal of the Formosan Medical Association
Issue number3
StatePublished - Mar 2023


  • Artificial intelligence
  • COVID-19
  • Chest X-rays
  • Intensive care unit
  • Mortality
  • Prognosis


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