Improved ICU mortality prediction based on SOFA scores and gastrointestinal parameters


Autoři: Yehudit Aperstein aff001;  Lidor Cohen aff001;  Itai Bendavid aff002;  Jonathan Cohen aff002;  Elad Grozovsky aff002;  Tammy Rotem aff001;  Pierre Singer aff002
Působiště autorů: Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel aff001;  Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222599

Souhrn

Background

The Sequential Organ Failure Assessment (SOFA) score is commonly used in ICUs around the world, designed to assess the severity of the patient's clinical state based on function/dysfunction of six major organ systems. The goal of this work is to build a computational model to predict mortality based on a series of SOFA scores. In addition, we examined the possibility of improving the prediction by incorporating a new component designed to measure the performance of the gastrointestinal system, added to the other six components.

Methods

In this retrospective study, we used patients’ three latest SOFA scores recorded during an individual ICU stay as input to different machine learning models and ensemble learning models. We added three validated parameters representing gastrointestinal failure. Among others, we used classification models such as Support Vector Machines (SVMs), Neural Networks, Logistic Regression and a penalty function used to increase model robustness in regard to certain extreme cases, which may be found in ICU population. We used the Area under Curve (AUC) performance metric to examine performance.

Results

We found an ensemble model of linear and logistic regression achieves a higher AUC compared related works in past years. After incorporating the gastrointestinal failure score along with the penalty function, our best performing ensemble model resulted in an additional improvement in terms of AUC metrics. We implemented and compared 36 different models that were built using both the information from the SOFA score as well as that of the gastrointestinal system. All compared models have approximately similar and relatively large AUC (between 0.8645 and 0.9146) with the best results are achieved by incorporating the gastrointestinal parameters into the prediction models.

Conclusions

Our findings indicate that gastrointestinal parameters carry significant information as a mortality predictor in addition to the conventional SOFA score. This information improves the predictive power of machine learning models by extending the SOFA to include information related to gastrointestinal organ system. The described method improves mortality prediction by considering the dynamics of the extended SOFA score. Although tested on a limited data set, the results' stability across different models suggests robustness in real-time use.

Klíčová slova:

Artificial neural networks – Forecasting – Intensive care units – Linear regression analysis – Machine learning – Machine learning algorithms – Polynomials – Support vector machines


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 9

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