Developing and validating clinical features-based machine learning algorithms to predict influenza infection in influenza-like illness patients

Shang Kai Hung, Chin Chieh Wu, Avichandra Singh, Jin Hua Li, Christian Lee, Eric H. Chou, Andrew Pekosz, Richard Rothman, Kuan Fu Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

4 Scopus citations


Background: Seasonal influenza poses a significant risk, and patients can benefit from early diagnosis and treatment. However, underdiagnosis and undertreatment remain widespread. We developed and compared clinical feature-based machine learning (ML) algorithms that can accurately predict influenza infection in emergency departments (EDs) among patients with influenza-like illness (ILI). Material and methods: We conducted a prospective cohort study in five EDs in the US and Taiwan from 2015 to 2020. Adult patients visiting the EDs with symptoms of ILI were recruited and tested by real-time RT-PCR for influenza. We evaluated seven ML algorithms and compared their results with previously developed clinical prediction models. Results: Out of the 2189 enrolled patients, 1104 tested positive for influenza. The eXtreme Gradient Boosting achieved superior performance with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] = 0.79–0.85), with a sensitivity of 0.92 (95% CI = 0.88–0.95), specificity of 0.89 (95% CI = 0.86–0.92), and accuracy of 0.72 (95% CI = 0.69–0.76) in the testing set over cut-offs of 0.4, 0.6 and 0.5, respectively. These results were superior to those of previously proposed clinical prediction models. The model interpretation revealed that body temperature, cough, rhinorrhea, and exposure history were positively associated with and the days of illness and influenza vaccine were negatively associated with influenza infection. We also found the week of the influenza season, pulse rate, and oxygen saturation to be associated with influenza infection. Conclusions: The clinical feature-based ML model outperformed conventional models for predicting influenza infection.

Original languageEnglish
Article number100561
Pages (from-to)100561
JournalBiomedical Journal
Issue number5
StatePublished - 10 2023

Bibliographical note

Copyright © 2022 Chang Gung University. All rights reserved.


  • Influenza infection
  • Influenza-like illness
  • Machine learning
  • Prediction model
  • Influenza, Human/diagnosis
  • Influenza Vaccines/therapeutic use
  • Prospective Studies
  • Algorithms
  • Humans
  • Adult
  • Machine Learning


Dive into the research topics of 'Developing and validating clinical features-based machine learning algorithms to predict influenza infection in influenza-like illness patients'. Together they form a unique fingerprint.

Cite this