Development of a prediction score for in-hospital mortality in COVID-19 patients with acute kidney injury: a machine learning approach.
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ABSTRACT:
SUBMITTER: Ponce D
PROVIDER: S-EPMC8709848 | biostudies-literature | 2021 Dec
REPOSITORIES: biostudies-literature
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Development of a prediction score for in-hospital mortality in COVID-19 patients with acute kidney injury: a machine learning approach.
Ponce Daniela D de Andrade Luís Gustavo Modelli LGM Claure-Del Granado Rolando R Ferreiro-Fuentes Alejandro A Lombardi Raul R
Scientific reports 20211224 1
Acute kidney injury (AKI) is frequently associated with COVID-19 and it is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting in-hospital mortality in COVID-19 patients with AKI (AKI-COV score). This was a cross-sectional multicentre prospective cohort study in the Latin America AKI COVID-19 Registry. A total of 870 COVID-19 patients with AKI defined according to the KDIGO were included between 1 May 2020 and 31 December 2020. We evaluated ...[more]
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Project description:ObjectivesThis study aims to develop and validate a prediction model in-hospital mortality in critically ill patients with sepsis-associated acute kidney injury (SA-AKI) based on machine learning algorithms.MethodsPatients who met the criteria for inclusion were identified in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and divided according to the validation (n = 2440) and development (n = 9756, 80%) queues. Ensemble stepwise feature selection method was used to screen for effective features. The prediction models of short-term mortality were developed by seven machine learning algorithms. Ten-fold cross-validation was used to verify the performance of the algorithm in the development queue. The area under the receiver operating characteristic curve (ROC-AUC) was used to evaluate the differentiation accuracy and performance of the prediction model in the validation queue. The best-performing model was interpreted by Shapley additive explanations (SHAP).ResultsA total of 12,196 patients were enrolled in this study. Eleven variables were finally chosen to develop the prediction model. The AUC of the random forest (RF) model was the highest value both in the Ten-fold cross-validation and evaluation (AUC: 0.798, 95% CI: 0.774-0.821). According to the SHAP plots, old age, low Glasgow Coma Scale (GCS) score, high AKI stage, reduced urine output, high Simplified Acute Physiology Score (SAPS II), high respiratory rate, low temperature, low absolute lymphocyte count, high creatinine level, dysnatremia, and low body mass index (BMI) increased the risk of poor prognosis.ConclusionsThe RF model developed in this study is a good predictor of in-hospital mortality for patients with SA-AKI in the intensive care unit (ICU), which may have potential applications in mortality prediction.
| S-EPMC10878338 | biostudies-literature
Project description:BackgroundSepsis-associated acute kidney injury (SA-AKI) is a severe complication associated with poorer prognosis and increased mortality, particularly in elderly patients. Currently, there is a lack of accurate mortality risk prediction models for these patients in clinic.ObjectivesThis study aimed to develop and validate machine learning models for predicting in-hospital mortality risk in elderly patients with SA-AKI.MethodsMachine learning models were developed and validated using the public, high-quality Medical Information Mart for Intensive Care (MIMIC)-IV critically ill database. The recursive feature elimination (RFE) algorithm was employed for key feature selection. Eleven predictive models were compared, with the best one selected for further validation. Shapley Additive Explanations (SHAP) values were used for visualization and interpretation, making the machine learning models clinically interpretable.ResultsThere were 16,154 patients with SA-AKI in the MIMIC-IV database, and 8426 SA-AKI patients were included in this study (median age: 77.0 years; female: 45%). 7728 patients excluded based on these criteria. They were randomly divided into a training cohort (5,934, 70%) and a validation cohort (2,492, 30%). Nine key features were selected by the RFE algorithm. The CatBoost model achieved the best performance, with an AUC of 0.844 in the training cohort and 0.804 in the validation cohort. SHAP values revealed that AKI stage, PaO2, and lactate were the top three most important features contributing to the CatBoost model.ConclusionWe developed a model capable of predicting the risk of in-hospital mortality in elderly patients with SA-AKI.
| S-EPMC10901004 | biostudies-literature
Project description:IntroductionAcute kidney injury (AKI) is a prevalent complication in older people, elevating the risks of acute kidney disease (AKD) and mortality. AKD reflects the adverse events developing after AKI. We aimed to develop and validate machine learning models for predicting the occurrence of AKD, AKI and mortality in older patients.MethodsWe retrospectively reviewed the medical records of older patients (aged 65 years and above). To explore the trajectory of kidney dysfunction, patients were categorized into four groups: no kidney disease, AKI recovery, AKD without AKI, or AKD with AKI. We developed eight machine learning models to predict AKD, AKI, and mortality. The best-performing model was identified based on the area under the receiver operating characteristic curve (AUC) and interpreted using the Shapley additive explanations (SHAP) method.ResultsA total of 22,005 patients were finally included in our study. Among them, 4,434 patients (20.15%) developed AKD, 4,000 (18.18%) occurred AKI, and 866 (3.94%) patients deceased. Light gradient boosting machine (LGBM) outperformed in predicting AKD, AKI, and mortality, and the final lite models with 15 features had AUC values of 0.760, 0.767, and 0.927, respectively. The SHAP method revealed that AKI stage, albumin, lactate dehydrogenase, aspirin and coronary heart disease were the top 5 predictors of AKD. An online prediction website for AKD and mortality was developed based on the final models.DiscussionThe LGBM models provide a valuable tool for early prediction of AKD, AKI, and mortality in older patients, facilitating timely interventions. This study highlights the potential of machine learning in improving older adult care, with the developed online tool offering practical utility for healthcare professionals. Further research should aim at external validation and integration of these models into clinical practice.
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Project description:BackgroundThis study aimed to identify the risk factors for in-hospital acute kidney injury (AKI) in patients with acute aortic dissection (AAD) and to establish a machine learning model for predicting in-hospital AKI.MethodsWe extracted data on patients with AAD from the Medical Information Mart for Intensive Care (MIMIC)-IV database and developed seven machine learning models: support vector machine (SVM), gradient boosting machine (GBM), neural network (NNET), eXtreme gradient boosting (XGBoost), K-nearest neighbors (KNN), light gradient boosting machine (LightGBM), and categorical boosting (CatBoost). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), and the optimal model was interpreted using Shapley Additive explanations (SHAP) visualization analysis.ResultsA total of 325 patients with AAD were identified from the MIMIC-IV database, of which 84 patients (25.85%) developed in-hospital AKI. This study collected 42 features, with nine selected for model building. A total of 70% of the patients were randomly allocated to the training set, while the remaining 30% were allocated to the test set. Machine learning models were built on the training set and validated using the test set. In addition, we collected AAD patient data from the MIMIC-III database for external validation. Among the seven machine learning models, the CatBoost model performed the best, with an AUC of 0.876 in the training set and 0.723 in the test set. CatBoost also performed strongly during the validation, achieving an AUC of 0.712. SHAP visualization analysis identified the most important risk factors for in-hospital AKI in AAD patients as maximum blood urea nitrogen (BUN), body mass index (BMI), urine output, maximum glucose (GLU), minimum BUN, minimum creatinine, maximum creatinine, weight and acute physiology score III (APSIII).ConclusionsThe CatBoost model, constructed using risk factors including maximum and minimum BUN levels, BMI, urine output, and maximum GLU, effectively predicts the risk of in-hospital AKI in AAD patients and shows compelling results in further validations.
| S-EPMC11868902 | biostudies-literature
Project description:Background: Acute ischemic stroke is a leading cause of death in the United States. Identifying patients with stroke at high risk of mortality is crucial for timely intervention and optimal resource allocation. This study aims to develop and validate machine learning-based models to predict in-hospital mortality risk for intensive care unit (ICU) patients with acute ischemic stroke and identify important associated factors. Methods: Our data include 3,489 acute ischemic stroke admissions to the ICU for patients not discharged or dead within 48 h from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Demographic, hospitalization type, procedure, medication, intake (intravenous and oral), laboratory, vital signs, and clinical assessment [e.g., Glasgow Coma Scale Scores (GCS)] during the initial 48 h of admissions were used to predict in-hospital mortality after 48 h of ICU admission. We explored 3 machine learning models (random forests, logistic regression, and XGBoost) and applied Bayesian optimization for hyperparameter tuning. Important features were identified using learned coefficients. Results: Experiments show that XGBoost tuned for area under the receiver operating characteristic curve (AUC ROC) was the best performing model (AUC ROC 0.86, F1 0.52), compared to random forests (AUC ROC 0.85, F1 0.47) and logistic regression (AUC ROC 0.75, F1 0.40). Top features include GCS, blood urea nitrogen, and Richmond RASS score. The model also demonstrates good fairness for males versus females and across racial/ethnic groups. Conclusions: Machine learning has shown great potential in predicting in-hospital mortality risk for people with acute ischemic stroke in the ICU setting. However, more ethical considerations need to be applied to ensure that performance differences across different racial/ethnic groups will not exacerbate existing health disparities and will not harm historically marginalized populations.
| S-EPMC11912875 | biostudies-literature
Project description:BackgroundAcute kidney injury (AKI) represents a frequent and grave complication associated with acute pancreatitis (AP), substantially elevating both mortality rates and the financial burden of hospitalization. The aim of our study is to construct a predictive model utilizing automated machine learning (AutoML) algorithms for the early prediction of AKI in patients with AP.MethodsWe retrospectively analyzed patients who were diagnosed with AP in our hospital from January 2017 to December 2021. These patients were randomly allocated into a training set and a validation set at a ratio of 7:3. To develop predictive models for each set, we employed the least absolute shrinkage and selection operator (LASSO) algorithm along with AutoML. A nomogram was developed based on multivariate logistic regression analysis outcomes. The model's efficacy was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Additionally, the performance of the model constructed via AutoML was evaluated using decision curve analysis (DCA), feature importance, SHapley Additive exPlanations (SHAP) plots, and locally interpretable model-agnostic explanations (LIME).ResultsThis study incorporated a total of 437 patients who met the inclusion criteria. Out of these, 313 were assigned to the training cohort and 124 to the validation cohort. In the training and validation cohorts, AKI occurred in 68 (21.7%) and 29(23.4%) patients, respectively. Comparative analysis revealed that the AutoML models exhibited enhanced performance over traditional logistic regression (LR). Furthermore, the deep learning (DL) model demonstrated superior predictive accuracy, evidenced by an area under the ROC curve of 0.963 in the training set and 0.830 in the validation set, surpassing other comparative models. The key variables identified as significant in the DL model within the training dataset included creatinine (Cr), urea (Urea), international normalized ratio (INR), etiology, smoking, alanine aminotransferase (ALT), hypertension, prothrombin time (PT), lactate dehydrogenase (LDH), and diabetes.ConclusionThe AutoML model, utilizing DL algorithm, offers considerable clinical significance in the early detection of AKI among patients with AP.
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Project description:Acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is associated with a significant risk of morbidity and mortality. The traditional risk model provided by the National Cardiovascular Data Registry (NCDR) is useful for predicting the preprocedural risk of AKI, although the scoring system requires a number of clinical contents. We sought to examine whether machine learning (ML) techniques could predict AKI with fewer NCDR-AKI risk model variables within a comparable PCI database in Japan. We evaluated 19,222 consecutive patients undergoing PCI between 2008 and 2019 in a Japanese multicenter registry. AKI was defined as an absolute or a relative increase in serum creatinine of 0.3 mg/dL or 50%. The data were split into training (N = 16,644; 2008-2017) and testing datasets (N = 2578; 2017-2019). The area under the curve (AUC) was calculated using the light gradient boosting model (GBM) with selected variables by Lasso and SHapley Additive exPlanations (SHAP) methods among 12 traditional variables, excluding the use of an intra-aortic balloon pump, since its use was considered operator-dependent. The incidence of AKI was 9.4% in the cohort. Lasso and SHAP methods demonstrated that seven variables (age, eGFR, preprocedural hemoglobin, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction/unstable angina, heart failure symptoms, and cardiogenic shock) were pertinent. AUC calculated by the light GBM with seven variables had a performance similar to that of the conventional logistic regression prediction model that included 12 variables (light GBM, AUC [training/testing datasets]: 0.779/0.772; logistic regression, AUC [training/testing datasets]: 0.797/0.755). The AKI risk model after PCI using ML enabled adequate risk quantification with fewer variables. ML techniques may aid in enhancing the international use of validated risk models.
| S-EPMC8760264 | biostudies-literature
Project description:BackgroundAcute kidney injury (AKI) is a complication that occurs for various reasons after surgery, especially cardiac surgery. This complication can lead to a prolonged treatment process, increased costs, and sometimes death. Prediction of postoperative AKI can help anesthesiologists to implement preventive and early treatment strategies to reduce the risk of AKI.ObjectivesThis study tries to predict postoperative AKI using interpretable machine learning models.MethodsFor this study, the information of 1435 patients was collected from multiple centers. The gathered data are in six categories: demographic characteristics and type of surgery, past medical history (PMH), drug history (DH), laboratory information, anesthesia and surgery information, and postoperative variables. Machine learning methods, including support vector machine (SVM), multilayer perceptron (MLP), decision tree (DT), random forest (RF), logistic regression, XGBoost, and AdaBoost, were used to predict postoperative AKI. Local interpretable model-agnostic explanations (LIME) and the Shapley methods were then leveraged to check the interpretability of models.ResultsComparing the area under the curves (AUCs) obtained for different machine learning models show that the RF and XGBoost methods with values of 0.81 and 0.80 best predict postoperative AKI. The interpretations obtained for the machine learning models show that creatinine (Cr), cardiopulmonary bypass time (CPB time), blood sugar (BS), and albumin (Alb) have the most significant impact on predictions.ConclusionsThe treatment team can be informed about the possibility of postoperative AKI before cardiac surgery using machine learning models such as RF and XGBoost and adjust the treatment procedure accordingly. Interpretability of predictions for each patient ensures the validity of obtained predictions.
| S-EPMC10016126 | biostudies-literature
Project description:ImportanceAcute kidney injury (AKI) is associated with increased morbidity and mortality in hospitalized patients. Current methods to identify patients at high risk of AKI are limited, and few prediction models have been externally validated.ObjectiveTo internally and externally validate a machine learning risk score to detect AKI in hospitalized patients.Design, setting, and participantsThis diagnostic study included 495 971 adult hospital admissions at the University of Chicago (UC) from 2008 to 2016 (n = 48 463), at Loyola University Medical Center (LUMC) from 2007 to 2017 (n = 200 613), and at NorthShore University Health System (NUS) from 2006 to 2016 (n = 246 895) with serum creatinine (SCr) measurements. Patients with an SCr concentration at admission greater than 3.0 mg/dL, with a prior diagnostic code for chronic kidney disease stage 4 or higher, or who received kidney replacement therapy within 48 hours of admission were excluded. A simplified version of a previously published gradient boosted machine AKI prediction algorithm was used; it was validated internally among patients at UC and externally among patients at NUS and LUMC.Main outcomes and measuresPrediction of Kidney Disease Improving Global Outcomes SCr-defined stage 2 AKI within a 48-hour interval was the primary outcome. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC).ResultsThe study included 495 971 adult admissions (mean [SD] age, 63 [18] years; 87 689 [17.7%] African American; and 266 866 [53.8%] women) across 3 health systems. The development of stage 2 or higher AKI occurred in 15 664 of 48 463 patients (3.4%) in the UC cohort, 5711 of 200 613 (2.8%) in the LUMC cohort, and 3499 of 246 895 (1.4%) in the NUS cohort. In the UC cohort, 332 patients (0.7%) required kidney replacement therapy compared with 672 patients (0.3%) in the LUMC cohort and 440 patients (0.2%) in the NUS cohort. The AUCs for predicting at least stage 2 AKI in the next 48 hours were 0.86 (95% CI, 0.86-0.86) in the UC cohort, 0.85 (95% CI, 0.84-0.85) in the LUMC cohort, and 0.86 (95% CI, 0.86-0.86) in the NUS cohort. The AUCs for receipt of kidney replacement therapy within 48 hours were 0.96 (95% CI, 0.96-0.96) in the UC cohort, 0.95 (95% CI, 0.94-0.95) in the LUMC cohort, and 0.95 (95% CI, 0.94-0.95) in the NUS cohort. In time-to-event analysis, a probability cutoff of at least 0.057 predicted the onset of stage 2 AKI a median (IQR) of 27 (6.5-93) hours before the eventual doubling in SCr concentrations in the UC cohort, 34.5 (19-85) hours in the NUS cohort, and 39 (19-108) hours in the LUMC cohort.Conclusions and relevanceIn this study, the machine learning algorithm demonstrated excellent discrimination in both internal and external validation, supporting its generalizability and potential as a clinical decision support tool to improve AKI detection and outcomes.
| S-EPMC7420241 | biostudies-literature
Project description:BackgroundSepsis-associated acute kidney injury (S-AKI) is considered to be associated with high morbidity and mortality, a commonly accepted model to predict mortality is urged consequently. This study used a machine learning model to identify vital variables associated with mortality in S-AKI patients in the hospital and predict the risk of death in the hospital. We hope that this model can help identify high-risk patients early and reasonably allocate medical resources in the intensive care unit (ICU).MethodsA total of 16,154 S-AKI patients from the Medical Information Mart for Intensive Care IV database were examined as the training set (80%) and the validation set (20%). Variables (129 in total) were collected, including basic patient information, diagnosis, clinical data, and medication records. We developed and validated machine learning models using 11 different algorithms and selected the one that performed the best. Afterward, recursive feature elimination was used to select key variables. Different indicators were used to compare the prediction performance of each model. The SHapley Additive exPlanations package was applied to interpret the best machine learning model in a web tool for clinicians to use. Finally, we collected clinical data of S-AKI patients from two hospitals for external validation.ResultsIn this study, 15 critical variables were finally selected, namely, urine output, maximum blood urea nitrogen, rate of injection of norepinephrine, maximum anion gap, maximum creatinine, maximum red blood cell volume distribution width, minimum international normalized ratio, maximum heart rate, maximum temperature, maximum respiratory rate, minimum fraction of inspired O2, minimum creatinine, minimum Glasgow Coma Scale, and diagnosis of diabetes and stroke. The categorical boosting algorithm model presented significantly better predictive performance [receiver operating characteristic (ROC): 0.83] than other models [accuracy (ACC): 75%, Youden index: 50%, sensitivity: 75%, specificity: 75%, F1 score: 0.56, positive predictive value (PPV): 44%, and negative predictive value (NPV): 92%]. External validation data from two hospitals in China were also well validated (ROC: 0.75).ConclusionsAfter selecting 15 crucial variables, a machine learning-based model for predicting the mortality of S-AKI patients was successfully established and the CatBoost model demonstrated best predictive performance.
| S-EPMC10106833 | biostudies-literature