Prediction of sepsis mortality in ICU patients using machine learning methods.

PROBLEM: Sepsis, a life-threatening condition, accounts for the deaths of millions of people worldwide. Accurate prediction of sepsis outcomes is crucial for effective treatment and management. Previous studies have utilized machine learning for prognosis, but have limitations in feature sets and model interpretability. AIM: This study aims to develop a machine learning model that enhances prediction accuracy for sepsis outcomes using a reduced set of features, thereby addressing the limitations of previous studies and enhancing model interpretability. METHODS: This study analyzes intensive care patient outcomes using the MIMIC-IV database, focusing on adult sepsis cases. Employing the latest data extraction tools, such as Google BigQuery, and following stringent selection criteria, we selected 38 features in this study. This selection is also informed by a comprehensive literature review and clinical expertise. Data preprocessing included handling missing values, regrouping categorical variables, and using the Synthetic Minority Over-sampling Technique (SMOTE) to balance the data. We evaluated several machine learning models: Decision Trees, Gradient Boosting, XGBoost, LightGBM, Multilayer Perceptrons (MLP), Support Vector Machines (SVM), and Random Forest. The Sequential Halving and Classification (SHAC) algorithm was used for hyperparameter tuning, and both train-test split and cross-validation methodologies were employed for performance and computational efficiency. RESULTS: The Random Forest model was the most effective, achieving an area under the receiver operating characteristic curve (AUROC) of 0.94 with a confidence interval of ±0.01. This significantly outperformed other models and set a new benchmark in the literature. The model also provided detailed insights into the importance of various clinical features, with the Sequential Organ Failure Assessment (SOFA) score and average urine output being highly predictive. SHAP (Shapley Additive Explanations) analysis further enhanced the model's interpretability, offering a clearer understanding of feature impacts. CONCLUSION: This study demonstrates significant improvements in predicting sepsis outcomes using a Random Forest model, supported by advanced machine learning techniques and thorough data preprocessing. Our approach provided detailed insights into the key clinical features impacting sepsis mortality, making the model both highly accurate and interpretable. By enhancing the model's practical utility in clinical settings, we offer a valuable tool for healthcare professionals to make data-driven decisions, ultimately aiming to minimize sepsis-induced fatalities.

Prediction of 30-day mortality for ICU patients with Sepsis-3.

BACKGROUND: There is a growing demand for advanced methods to improve the understanding and prediction of illnesses. This study focuses on Sepsis, a critical response to infection, aiming to enhance early detection and mortality prediction for Sepsis-3 patients to improve hospital resource allocation. METHODS: In this study, we developed a Machine Learning (ML) framework to predict the 30-day mortality rate of ICU patients with Sepsis-3 using the MIMIC-III database. Advanced big data extraction tools like Snowflake were used to identify eligible patients. Decision tree models and Entropy Analyses helped refine feature selection, resulting in 30 relevant features curated with clinical experts. We employed the Light Gradient Boosting Machine (LightGBM) model for its efficiency and predictive power. RESULTS: The study comprised a cohort of 9118 Sepsis-3 patients. Our preprocessing techniques significantly improved both the AUC and accuracy metrics. The LightGBM model achieved an impressive AUC of 0.983 (95% CI: [0.980-0.990]), an accuracy of 0.966, and an F1-score of 0.910. Notably, LightGBM showed a substantial 6% improvement over our best baseline model and a 14% enhancement over the best existing literature. These advancements are attributed to (I) the inclusion of the novel and pivotal feature Hospital Length of Stay (HOSP_LOS), absent in previous studies, and (II) LightGBM's gradient boosting architecture, enabling robust predictions with high-dimensional data while maintaining computational efficiency, as demonstrated by its learning curve. CONCLUSIONS: Our preprocessing methodology reduced the number of relevant features and identified a crucial feature overlooked in previous studies. The proposed model demonstrated high predictive power and generalization capability, highlighting the potential of ML in ICU settings. This model can streamline ICU resource allocation and provide tailored interventions for Sepsis-3 patients.

Predicting clinical outcomes among hospitalized COVID-19 patients using both local and published models.

BACKGROUND: Many models are published which predict outcomes in hospitalized COVID-19 patients. The generalizability of many is unknown. We evaluated the performance of selected models from the literature and our own models to predict outcomes in patients at our institution. METHODS: We searched the literature for models predicting outcomes in inpatients with COVID-19. We produced models of mortality or criticality (mortality or ICU admission) in a development cohort. We tested external models which provided sufficient information and our models using a test cohort of our most recent patients. The performance of models was compared using the area under the receiver operator curve (AUC). RESULTS: Our literature review yielded 41 papers. Of those, 8 were found to have sufficient documentation and concordance with features available in our cohort to implement in our test cohort. All models were from Chinese patients. One model predicted criticality and seven mortality. Tested against the test cohort, internal models had an AUC of 0.84 (0.74-0.94) for mortality and 0.83 (0.76-0.90) for criticality. The best external model had an AUC of 0.89 (0.82-0.96) using three variables, another an AUC of 0.84 (0.78-0.91) using ten variables. AUC's ranged from 0.68 to 0.89. On average, models tested were unable to produce predictions in 27% of patients due to missing lab data. CONCLUSION: Despite differences in pandemic timeline, race, and socio-cultural healthcare context some models derived in China performed well. For healthcare organizations considering implementation of an external model, concordance between the features used in the model and features available in their own patients may be important. Analysis of both local and external models should be done to help decide on what prediction method is used to provide clinical decision support to clinicians treating COVID-19 patients as well as what lab tests should be included in order sets.

REDECA: A Novel Framework to Review Artificial Intelligence and Its Applications in Occupational Safety and Health.

INTRODUCTION: The field of artificial intelligence (AI) is rapidly expanding, with many applications seen routinely in health care, industry, and education, and increasingly in workplaces. Although there is growing evidence of applications of AI in workplaces across all industries to simplify and/or automate tasks there is a limited understanding of the role that AI contributes in addressing occupational safety and health (OSH) concerns. METHODS: This paper introduces a new framework called Risk Evolution, Detection, Evaluation, and Control of Accidents (REDECA) that highlights the role that AI plays in the anticipation and control of exposure risks in a worker's immediate environment. Two hundred and sixty AI papers across five sectors (oil and gas, mining, transportation, construction, and agriculture) were reviewed using the REDECA framework to highlight current applications and gaps in OSH and AI fields. RESULTS: The REDECA framework highlighted the unique attributes and research focus of each of the five industrial sectors. The majority of evidence of AI in OSH research within the oil/gas and transportation sectors focused on the development of sensors to detect hazardous situations. In construction the focus was on the use of sensors to detect incidents. The research in the agriculture sector focused on sensors and actuators that removed workers from hazardous conditions. Application of the REDECA framework highlighted AI/OSH strengths and opportunities in various industries and potential areas for collaboration. CONCLUSIONS: As AI applications across industries continue to increase, further exploration of the benefits and challenges of AI applications in OSH is needed to optimally protect worker health, safety and well-being.