Evaluating machine learning models for sepsis prediction: A systematic review of methodologies.
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ABSTRACT:
SUBMITTER: Deng HF
PROVIDER: S-EPMC8741489 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
Publications
Evaluating machine learning models for sepsis prediction: A systematic review of methodologies.
Deng Hong-Fei HF Sun Ming-Wei MW Wang Yu Y Zeng Jun J Yuan Ting T Li Ting T Li Di-Huan DH Chen Wei W Zhou Ping P Wang Qi Q Jiang Hua H
iScience 20211220 1
Studies for sepsis prediction using machine learning are developing rapidly in medical science recently. In this review, we propose a set of new evaluation criteria and reporting standards to assess 21 qualified machine learning models for quality analysis based on PRISMA. Our assessment shows that (1.) the definition of sepsis is not consistent among the studies; (2.) data sources and data preprocessing methods, machine learning models, feature engineering, and inclusion types vary widely among ...[more]
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Project description:Background: Sepsis is among the leading causes of death in intensive care units (ICUs) worldwide and its recognition, particularly in the early stages of the disease, remains a medical challenge. The advent of an affluence of available digital health data has created a setting in which machine learning can be used for digital biomarker discovery, with the ultimate goal to advance the early recognition of sepsis. Objective: To systematically review and evaluate studies employing machine learning for the prediction of sepsis in the ICU. Data Sources: Using Embase, Google Scholar, PubMed/Medline, Scopus, and Web of Science, we systematically searched the existing literature for machine learning-driven sepsis onset prediction for patients in the ICU. Study Eligibility Criteria: All peer-reviewed articles using machine learning for the prediction of sepsis onset in adult ICU patients were included. Studies focusing on patient populations outside the ICU were excluded. Study Appraisal and Synthesis Methods: A systematic review was performed according to the PRISMA guidelines. Moreover, a quality assessment of all eligible studies was performed. Results: Out of 974 identified articles, 22 and 21 met the criteria to be included in the systematic review and quality assessment, respectively. A multitude of machine learning algorithms were applied to refine the early prediction of sepsis. The quality of the studies ranged from "poor" (satisfying ≤ 40% of the quality criteria) to "very good" (satisfying ≥ 90% of the quality criteria). The majority of the studies (n = 19, 86.4%) employed an offline training scenario combined with a horizon evaluation, while two studies implemented an online scenario (n = 2, 9.1%). The massive inter-study heterogeneity in terms of model development, sepsis definition, prediction time windows, and outcomes precluded a meta-analysis. Last, only two studies provided publicly accessible source code and data sources fostering reproducibility. Limitations: Articles were only eligible for inclusion when employing machine learning algorithms for the prediction of sepsis onset in the ICU. This restriction led to the exclusion of studies focusing on the prediction of septic shock, sepsis-related mortality, and patient populations outside the ICU. Conclusions and Key Findings: A growing number of studies employs machine learning to optimize the early prediction of sepsis through digital biomarker discovery. This review, however, highlights several shortcomings of the current approaches, including low comparability and reproducibility. Finally, we gather recommendations how these challenges can be addressed before deploying these models in prospective analyses. Systematic Review Registration Number: CRD42020200133.
| S-EPMC8193357 | biostudies-literature
Project description:BackgroundSepsis, a life-threatening infection-induced inflammatory condition, has significant global health impacts. Timely detection is crucial for improving patient outcomes as sepsis can rapidly progress to severe forms. The application of machine learning (ML) and deep learning (DL) to predict sepsis using electronic health records (EHRs) has gained considerable attention for timely intervention.MethodsPubMed, IEEE Xplore, Google Scholar, and Scopus were searched for relevant studies. All studies that used ML/DL to detect or early-predict the onset of sepsis in the adult population using EHRs were considered. Data were extracted and analyzed from all studies that met the criteria and were also evaluated for their quality.ResultsThis systematic review examined 1942 articles, selecting 42 studies while adhering to strict criteria. The chosen studies were predominantly retrospective (n = 38) and spanned diverse geographic settings, with a focus on the United States. Different datasets, sepsis definitions, and prevalence rates were employed, necessitating data augmentation. Heterogeneous parameter utilization, diverse model distribution, and varying quality assessments were observed. Longitudinal data enabled early sepsis prediction, and quality criteria fulfillment varied, with inconsistent funding-article quality correlation.ConclusionsThis systematic review underscores the significance of ML/DL methods for sepsis detection and early prediction through EHR data.
| S-EPMC10488449 | biostudies-literature
Project description:BackgroundSepsis-associated acute kidney injury (S-AKI) has a significant impact on patient survival, with continuous renal replacement therapy (CRRT) being a crucial intervention. However, the optimal timing for CRRT initiation remains controversial.MethodsUsing the MIMIC-IV database for model development and the eICU database for external validation, we analyzed patients with S-AKI to compare survival rates between early and late CRRT initiation groups. Propensity score matching was performed to address potential selection bias. Subgroup analyses stratified patients by disease severity using SOFA scores (low ≤10, medium 11-15, high >15) and creatinine levels (low ≤3 mg/dL, medium 3-5 mg/dL, high >5 mg/dL). Multiple machine learning models were developed and evaluated to predict patient prognosis, with Shapley Additive exPlanations (SHAP) analysis identifying key prognostic factors.ResultsAfter propensity score matching, late CRRT initiation was associated with improved survival probability, but led to increased hospital and ICU stays. Subgroup analyses showed consistent trends favoring late CRRT across all SOFA categories, with the most pronounced effect in high SOFA scores (>15, p = 0.058). The GBM model demonstrated robust predictive performance (average C-index 0.694 in validation and test sets). SHAP analysis identified maximum lactate levels, age, and minimum SpO2 as the strongest predictors of mortality, while CRRT timing showed relatively lower impact on outcome prediction.ConclusionWhile later initiation of CRRT in S-AKI patients was associated with improved survival, this benefit comes with increased healthcare resource utilization. The clinical parameters, rather than CRRT timing, are the primary determinants of patient outcomes, suggesting the need for a more personalized approach to CRRT initiation based on overall illness severity.
| S-EPMC11794530 | biostudies-literature
Project description:Cancer is driven by distinctive sorts of changes and basic variations in genes. Recognizing cancer driver genes is basic for accurate oncological analysis. Numerous methodologies to distinguish and identify drivers presently exist, but efficient tools to combine and optimize them on huge datasets are few. Most strategies for prioritizing transformations depend basically on frequency-based criteria. Strategies are required to dependably prioritize organically dynamic driver changes over inert passengers in high-throughput sequencing cancer information sets. This study proposes a model namely PCDG-Pred which works as a utility capable of distinguishing cancer driver and passenger attributes of genes based on sequencing data. Keeping in view the significance of the cancer driver genes an efficient method is proposed to identify the cancer driver genes. Further, various validation techniques are applied at different levels to establish the effectiveness of the model and to obtain metrics like accuracy, Mathew's correlation coefficient, sensitivity, and specificity. The results of the study strongly indicate that the proposed strategy provides a fundamental functional advantage over other existing strategies for cancer driver genes identification. Subsequently, careful experiments exhibit that the accuracy metrics obtained for self-consistency, independent set, and cross-validation tests are 91.08%., 87.26%, and 92.48% respectively.
| S-EPMC8192921 | biostudies-literature
Project description:Machine learning (ML) studies are becoming increasingly popular in orthopedics but lack a critically appraisal of their adherence to peer-reviewed guidelines. The objective of this review was to (1) evaluate quality and transparent reporting of ML prediction models in orthopedic surgery based on the transparent reporting of multivariable prediction models for individual prognosis or diagnosis (TRIPOD), and (2) assess risk of bias with the Prediction model Risk Of Bias ASsessment Tool. A systematic review was performed to identify all ML prediction studies published in orthopedic surgery through June 18th, 2020. After screening 7138 studies, 59 studies met the study criteria and were included. Two reviewers independently extracted data and discrepancies were resolved by discussion with at least two additional reviewers present. Across all studies, the overall median completeness for the TRIPOD checklist was 53% (interquartile range 47%-60%). The overall risk of bias was low in 44% (n = 26), high in 41% (n = 24), and unclear in 15% (n = 9). High overall risk of bias was driven by incomplete reporting of performance measures, inadequate handling of missing data, and use of small datasets with inadequate outcome numbers. Although the number of ML studies in orthopedic surgery is increasing rapidly, over 40% of the existing models are at high risk of bias. Furthermore, over half incompletely reported their methods and/or performance measures. Until these issues are adequately addressed to give patients and providers trust in ML models, a considerable gap remains between the development of ML prediction models and their implementation in orthopedic practice.
| S-EPMC9290012 | biostudies-literature
Project description:Background and objectivesSepsis is accompanied by a considerably high risk of mortality in the short term, despite the availability of recommended mortality risk assessment tools. However, these risk assessment tools seem to have limited predictive value. With the gradual integration of machine learning into clinical practice, some researchers have attempted to employ machine learning for early mortality risk prediction in sepsis patients. Nevertheless, there is a lack of comprehensive understanding regarding the construction of predictive variables using machine learning and the value of various machine learning methods. Thus, we carried out this systematic review and meta-analysis to explore the predictive value of machine learning for sepsis-related death at different time points.MethodsPubMed, Embase, Cochrane, and Web of Science databases were searched until August 9th, 2022. The risk of bias in predictive models was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST). We also performed subgroup analysis according to time of death and type of model and summarized current predictive variables used to construct models for sepsis death prediction.ResultsFifty original studies were included, covering 104 models. The combined Concordance index (C-index), sensitivity, and specificity of machine learning models were 0.799, 0.81, and 0.80 in the training set, and 0.774, 0.71, and 0.68 in the validation set, respectively. Machine learning outperformed conventional clinical scoring tools and showed excellent C-index, sensitivity, and specificity in different subgroups. Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) are the preferred machine learning models because they showed more favorable accuracy with similar modeling variables. This study found that lactate was the most frequent predictor but was seriously ignored by current clinical scoring tools.ConclusionMachine learning methods demonstrate relatively favorable accuracy in predicting the mortality risk in sepsis patients. Given the limitations in accuracy and applicability of existing prediction scoring systems, there is an opportunity to explore updates based on existing machine learning approaches. Specifically, it is essential to develop or update more suitable mortality risk assessment tools based on the specific contexts of use, such as emergency departments, general wards, and intensive care units.
| S-EPMC10712076 | biostudies-literature
Project description:ObjectiveTo determine the effects of using unstructured clinical text in machine learning (ML) for prediction, early detection, and identification of sepsis.Materials and methodsPubMed, Scopus, ACM DL, dblp, and IEEE Xplore databases were searched. Articles utilizing clinical text for ML or natural language processing (NLP) to detect, identify, recognize, diagnose, or predict the onset, development, progress, or prognosis of systemic inflammatory response syndrome, sepsis, severe sepsis, or septic shock were included. Sepsis definition, dataset, types of data, ML models, NLP techniques, and evaluation metrics were extracted.ResultsThe clinical text used in models include narrative notes written by nurses, physicians, and specialists in varying situations. This is often combined with common structured data such as demographics, vital signs, laboratory data, and medications. Area under the receiver operating characteristic curve (AUC) comparison of ML methods showed that utilizing both text and structured data predicts sepsis earlier and more accurately than structured data alone. No meta-analysis was performed because of incomparable measurements among the 9 included studies.DiscussionStudies focused on sepsis identification or early detection before onset; no studies used patient histories beyond the current episode of care to predict sepsis. Sepsis definition affects reporting methods, outcomes, and results. Many methods rely on continuous vital sign measurements in intensive care, making them not easily transferable to general ward units.ConclusionsApproaches were heterogeneous, but studies showed that utilizing both unstructured text and structured data in ML can improve identification and early detection of sepsis.
| S-EPMC8800516 | biostudies-literature
Project description:BackgroundSepsis is a life-threatening condition caused by an abnormal response of the body to infection and imposes a significant health and economic burden worldwide due to its high mortality rate. Early recognition of sepsis is crucial for effective treatment. This study aimed to systematically evaluate the performance of various machine learning models in predicting the onset of sepsis.MethodsWe conducted a comprehensive search of the Cochrane Library, PubMed, Embase, and Web of Science databases, covering studies from database inception to November 14, 2022. We used the PROBAST tool to assess the risk of bias. We calculated the predictive performance for sepsis onset using the C-index and accuracy. We followed the PRISMA guidelines for this study.ResultsWe included 23 eligible studies with a total of 4,314,145 patients and 26 different machine learning models. The most frequently used models in the studies were random forest (n = 9), extreme gradient boost (n = 7), and logistic regression (n = 6) models. The random forest (test set n = 9, acc = 0.911) and extreme gradient boost (test set n = 7, acc = 0.957) models were the most accurate based on our analysis of the predictive performance. In terms of the C-index outcome, the random forest (n = 6, acc = 0.79) and extreme gradient boost (n = 7, acc = 0.83) models showed the highest performance.ConclusionMachine learning has proven to be an effective tool for predicting sepsis at an early stage. However, to obtain more accurate results, additional machine learning methods are needed. In our research, we discovered that the XGBoost and random forest models exhibited the best predictive performance and were most frequently utilized for predicting the onset of sepsis.Trial registrationCRD42022384015.
| S-EPMC10523763 | biostudies-literature
Project description:Purpose of reviewMachine learning (ML) approaches are an emerging alternative for healthcare risk prediction. We aimed to synthesise the literature on ML and classical regression studies exploring potential prognostic factors and to compare prediction performance for pre-eclampsia.Recent findingsFrom 9382 studies retrieved, 82 were included. Sixty-six publications exclusively reported eighty-four classical regression models to predict variable timing of onset of pre-eclampsia. Another six publications reported purely ML algorithms, whilst another 10 publications reported ML algorithms and classical regression models in the same sample with 8 of 10 findings that ML algorithms outperformed classical regression models. The most frequent prognostic factors were age, pre-pregnancy body mass index, chronic medical conditions, parity, prior history of pre-eclampsia, mean arterial pressure, uterine artery pulsatility index, placental growth factor, and pregnancy-associated plasma protein A. Top performing ML algorithms were random forest (area under the curve (AUC) = 0.94, 95% confidence interval (CI) 0.91-0.96) and extreme gradient boosting (AUC = 0.92, 95% CI 0.90-0.94). The competing risk model had similar performance (AUC = 0.92, 95% CI 0.91-0.92) compared with a neural network. Calibration performance was not reported in the majority of publications. ML algorithms had better performance compared to classical regression models in pre-eclampsia prediction. Random forest and boosting-type algorithms had the best prediction performance. Further research should focus on comparing ML algorithms to classical regression models using the same samples and evaluation metrics to gain insight into their performance. External validation of ML algorithms is warranted to gain insights into their generalisability.
| S-EPMC11199280 | biostudies-literature
Project description:Despite the fact that machine learning (ML) algorithms to construct predictive models for pressure injury development are widely reported, the performance of the model remains unknown. The goal of the review was to systematically appraise the performance of ML models in predicting pressure injury. PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Grey literature and other databases were systematically searched. Original journal papers were included which met the inclusion criteria. The methodological quality was assessed independently by two reviewers using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed with Metadisc software, with the area under the receiver operating characteristic curve, sensitivity and specificity as effect measures. Chi-squared and I2 tests were used to assess the heterogeneity. A total of 18 studies were included for the narrative review, and 14 of them were eligible for meta-analysis. The models achieved excellent pooled AUC of 0.94, sensitivity of 0.79 (95% CI [0.78-0.80]) and specificity of 0.87 (95% CI [0.88-0.87]). Meta-regressions did not provide evidence that model performance varied by data or model types. The present findings indicate that ML models show an outstanding performance in predicting pressure injury. However, good-quality studies should be conducted to verify our results and confirm the clinical value of ML in pressure injury development.
| S-EPMC10681397 | biostudies-literature