{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:38:01Z","timestamp":1781123881103,"version":"3.54.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Following the lifting of China\u2019s stringent lockdown policy on December 7, 2022, COVID-19 cases surged in a pattern, creating unprecedented strain on healthcare systems. The Omicron variant, characterized by high transmissibility and rapid spread, led to a sharp rise in infections. Understanding its clinical impact\u2014particularly on lung involvement percentage\u2014is crucial for optimizing patient care under such outbreak conditions. This study aimed to assess the extent of lung involvement percentage during the outbreak and its major associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The hospital\u2019s daily computed tomography examination volume was quantified using artificial intelligence\u2013based pulmonary inflammation analysis software and used as an indicator of epidemic intensity. Associations between lung involvement percentage and age, sex, and daily case counts were evaluated using GEE Logistic Regression, complemented by machine learning models. Model interpretation was performed using SHapley Additive exPlanations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GEE Logistic regression demonstrated that age was strongly associated with lung involvement (OR 1.0813, 95% CI 1.0703\u20131.0925,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001), while daily case counts also showed a small but significant independent association (OR 1.0033, 95% CI 1.0018\u20131.0047,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001). Sex exhibited only minimal association (OR 0.8098, 95% CI 0.6983\u20130.9391,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0053). Complementary machine learning analyses, including gradient boosting, identified age as the dominant contributor, followed by daily case counts with a small effect and sex with minimal contribution. SHAP analysis provided interpretable insights into how each feature influenced model predictions at both global and individual levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>During the Omicron surge, greater age and higher daily case counts were associated with higher lung involvement percentage. These associations highlight the relevance of demographic and epidemic factors in characterizing pulmonary findings during large-scale outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1728282","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T07:36:45Z","timestamp":1768462605000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Lung involvement percentage in patients with COVID-19 during the Omicron wave in China: a SHAP-explained machine learning study from a single center"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuhang","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongyuan","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiliang","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siwei","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongxing","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiujuan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biquan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"m1985","DOI":"10.1136\/bmj.m1985","article-title":"Features of 20\u202f133 UK patients in hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study","volume":"369","author":"Docherty","year":"2020","journal-title":"BMJ"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e044500","DOI":"10.1136\/bmjopen-2020-044500","article-title":"Prediction of COVID-19 severity using laboratory findings on admission: informative values, thresholds, ML model performance","volume":"11","author":"Statsenko","year":"2021","journal-title":"BMJ Open"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"6317","DOI":"10.1038\/s41467-020-19741-6","article-title":"Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission","volume":"11","author":"Peckham","year":"2020","journal-title":"Nat Commun"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1002\/bies.201200099","article-title":"Sex influences immune responses to viruses, and efficacy of prophylaxis and treatments for viral diseases","volume":"34","author":"Klein","year":"2012","journal-title":"BioEssays"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e13538","DOI":"10.1111\/apha.13538","article-title":"microRNAs as new possible actors in gender disparities of Covid-19 pandemic","volume":"230","author":"Pontecorvi","year":"2020","journal-title":"Acta Physiol (Oxf)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"567824","DOI":"10.3389\/fendo.2020.567824","article-title":"Vitamin D and sex differences in COVID-19","volume":"11","author":"Pagano","year":"2020","journal-title":"Front Endocrinol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"627260","DOI":"10.3389\/fphys.2021.627260","article-title":"The physiological mechanisms of the sex-based difference in outcomes of COVID19 infection","volume":"12","author":"Wray","year":"2021","journal-title":"Front Physiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"152","DOI":"10.3389\/fpubh.2020.00152","article-title":"Gender differences in patients with COVID-19: focus on severity and mortality","volume":"8","author":"Jin","year":"2020","journal-title":"Front Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e0241541","DOI":"10.1371\/journal.pone.0241541","article-title":"Factors associated with disease severity and mortality among patients with COVID-19: a systematic review and meta-analysis","volume":"15","author":"Chidambaram","year":"2020","journal-title":"PLoS One"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0247461","DOI":"10.1371\/journal.pone.0247461","article-title":"Population risk factors for severe disease and mortality in COVID-19: a global systematic review and meta-analysis","volume":"16","author":"Booth","year":"2021","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"60","DOI":"10.47391\/JPMA.5586","article-title":"Correlation between oxygen saturation of patient and severity index of Covid 19 pneumonia on CT","volume":"73","author":"Fatima","year":"2023","journal-title":"J Pak Med Assoc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.radi.2020.09.010","article-title":"Effectiveness of COVID-19 diagnosis and management tools: a review","volume":"27","author":"Alsharif","year":"2021","journal-title":"Radiography"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"839","DOI":"10.2214\/AJR.20.23202","article-title":"Chest CT and coronavirus disease (COVID-19): a critical review of the literature to date","volume":"215","author":"Raptis","year":"2020","journal-title":"AJR Am J Roentgenol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1148\/radiol.220533","article-title":"Reduction in chest CT severity and improved hospital outcomes in SARS-CoV-2 omicron compared with Delta variant infection","volume":"306","author":"Tsakok","year":"2023","journal-title":"Radiology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"903","DOI":"10.3390\/biomedicines11030901","article-title":"Comparative analysis of clinical and CT findings in patients with SARS-CoV-2 original strain, Delta and omicron variants","volume":"11","author":"Han","year":"2023","journal-title":"Biomedicine"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3038","DOI":"10.1093\/eurheartj\/ehaa623","article-title":"COVID-19 is, in the end, an endothelial disease","volume":"41","author":"Libby","year":"2020","journal-title":"Eur Heart J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1038\/s41577-021-00536-9","article-title":"Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19","volume":"21","author":"Bonaventura","year":"2021","journal-title":"Nat Rev Immunol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1097\/MOH.0000000000000666","article-title":"Mechanisms of immunothrombosis in COVID-19","volume":"28","author":"Portier","year":"2021","journal-title":"Curr Opin Hematol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1038\/s41577-022-00762-9","article-title":"Understanding COVID-19-associated coagulopathy","volume":"22","author":"Conway","year":"2022","journal-title":"Nat Rev Immunol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"10321","DOI":"10.1038\/s41598-023-37335-2","article-title":"The value of non-contrast chest CT in the prediction of myocardial injury in patients with the COVID-19 omicron variant","volume":"13","author":"Zhong","year":"2023","journal-title":"Sci Rep"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"m1966","DOI":"10.1136\/bmj.m1966","article-title":"Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in new York City: prospective cohort study","volume":"369","author":"Petrilli","year":"2020","journal-title":"BMJ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet (London, England)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet (London, England)"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"756","DOI":"10.12998\/wjcc.v11.i4.756","article-title":"Chest computed tomography findings of the omicron variants of SARS-CoV-2 with different cycle threshold values","volume":"11","author":"Ying","year":"2023","journal-title":"World J Clin Cases"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1177\/08850666211067509","article-title":"Association of Surge Conditions with mortality among critically ill patients with COVID-19","volume":"37","author":"Keene","year":"2022","journal-title":"J Intensive Care Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.7326\/M21-1213","article-title":"Association between caseload surge and COVID-19 survival in 558 U.S. hospitals, march to august 2020","volume":"174","author":"Kadri","year":"2021","journal-title":"Ann Intern Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1728282\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T07:36:48Z","timestamp":1768462608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1728282\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,15]]},"references-count":28,"alternative-id":["10.3389\/fpubh.2025.1728282"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1728282","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,15]]},"article-number":"1728282"}}