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Soliman MM, Marshall C, Kimball JP, Choudhary T, Clermont G, Pinsky MR, Buchman TG, Coopersmith CM, Inan OT, Kamaleswaran R. Parsimonious Waveform-derived Features consisting of Pulse Arrival Time and Heart Rate Variability Predicts the Onset of Septic Shock. Biomed Signal Process Control 2024; 92:105974. [PMID: 38559667 PMCID: PMC10977921 DOI: 10.1016/j.bspc.2024.105974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Sepsis is a major public health emergency and one of the leading causes of morbidity and mortality in critically ill patients. For each hour treatment is delayed, shock-related mortality increases, so early diagnosis and intervention is of utmost importance. However, earlier recognition of shock requires active monitoring, which may be delayed due to subclinical manifestations of the disease at the early phase of onset. Machine learning systems can increase timely detection of shock onset by exploiting complex interactions among continuous physiological waveforms. We use a dataset consisting of high-resolution physiological waveforms from intensive care unit (ICU) of a tertiary hospital system. We investigate the use of mean arterial blood pressure (MAP), pulse arrival time (PAT), heart rate variability (HRV), and heart rate (HR) for the early prediction of shock onset. Using only five minutes of the aforementioned vital signals from 239 ICU patients, our developed models can accurately predict septic shock onset 6 to 36 hours prior to clinical recognition with area under the receiver operating characteristic (AUROC) of 0.84 and 0.8 respectively. This work lays foundations for a robust, efficient, accurate and early prediction of septic shock onset which may help clinicians in their decision-making processes. This study introduces machine learning models that provide fast and accurate predictions of septic shock onset times up to 36 hours in advance. BP, PAT and HR dynamics can independently predict septic shock onset with a look-back period of only 5 mins.
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Affiliation(s)
- Moamen M. Soliman
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - Curtis Marshall
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, 30322, GA, USA
| | - Jacob P. Kimball
- School of Biomedical and Electrical Engineering, University of Portland, Portland, 97203, OR, USA
| | - Tilendra Choudhary
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, 30322, GA, USA
| | - Gilles Clermont
- School of Medicine, University of Pittsburgh, Pittsburgh, 15213, PA, USA
| | - Michael R. Pinsky
- School of Medicine, University of Pittsburgh, Pittsburgh, 15213, PA, USA
| | - Timothy G. Buchman
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, 30322, GA, USA
| | - Craig M. Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, 30322, GA, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, 30322, GA, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
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Bomrah S, Uddin M, Upadhyay U, Komorowski M, Priya J, Dhar E, Hsu SC, Syed-Abdul S. A scoping review of machine learning for sepsis prediction- feature engineering strategies and model performance: a step towards explainability. Crit Care 2024; 28:180. [PMID: 38802973 PMCID: PMC11131234 DOI: 10.1186/s13054-024-04948-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Sepsis, an acute and potentially fatal systemic response to infection, significantly impacts global health by affecting millions annually. Prompt identification of sepsis is vital, as treatment delays lead to increased fatalities through progressive organ dysfunction. While recent studies have delved into leveraging Machine Learning (ML) for predicting sepsis, focusing on aspects such as prognosis, diagnosis, and clinical application, there remains a notable deficiency in the discourse regarding feature engineering. Specifically, the role of feature selection and extraction in enhancing model accuracy has been underexplored. OBJECTIVES This scoping review aims to fulfill two primary objectives: To identify pivotal features for predicting sepsis across a variety of ML models, providing valuable insights for future model development, and To assess model efficacy through performance metrics including AUROC, sensitivity, and specificity. RESULTS The analysis included 29 studies across diverse clinical settings such as Intensive Care Units (ICU), Emergency Departments, and others, encompassing 1,147,202 patients. The review highlighted the diversity in prediction strategies and timeframes. It was found that feature extraction techniques notably outperformed others in terms of sensitivity and AUROC values, thus indicating their critical role in improving sepsis prediction models. CONCLUSION Key dynamic indicators, including vital signs and critical laboratory values, are instrumental in the early detection of sepsis. Applying feature selection methods significantly boosts model precision, with models like Random Forest and XG Boost showing promising results. Furthermore, Deep Learning models (DL) reveal unique insights, spotlighting the pivotal role of feature engineering in sepsis prediction, which could greatly benefit clinical practice.
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Affiliation(s)
- Sherali Bomrah
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 235, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, 235, Taiwan
- College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Mohy Uddin
- Research Quality Management Section, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, 11426, Riyadh, Saudi Arabia
| | - Umashankar Upadhyay
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 235, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, 235, Taiwan
- School of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, 173229, India
| | - Matthieu Komorowski
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College of London, South Kensington Campus, London, UK
| | - Jyoti Priya
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 235, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, 235, Taiwan
| | - Eshita Dhar
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 235, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, 235, Taiwan
| | - Shih-Chang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 106, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 235, Taiwan.
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, 235, Taiwan.
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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Arina P, Kaczorek MR, Hofmaenner DA, Pisciotta W, Refinetti P, Singer M, Mazomenos EB, Whittle J. Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools. Anesthesiology 2024; 140:85-101. [PMID: 37944114 PMCID: PMC11146190 DOI: 10.1097/aln.0000000000004764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The utilization of artificial intelligence and machine learning as diagnostic and predictive tools in perioperative medicine holds great promise. Indeed, many studies have been performed in recent years to explore the potential. The purpose of this systematic review is to assess the current state of machine learning in perioperative medicine, its utility in prediction of complications and prognostication, and limitations related to bias and validation. METHODS A multidisciplinary team of clinicians and engineers conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Multiple databases were searched, including Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Medline, Embase, and Web of Science. The systematic review focused on study design, type of machine learning model used, validation techniques applied, and reported model performance on prediction of complications and prognostication. This review further classified outcomes and machine learning applications using an ad hoc classification system. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability of the studies. RESULTS A total of 103 studies were identified. The models reported in the literature were primarily based on single-center validations (75%), with only 13% being externally validated across multiple centers. Most of the mortality models demonstrated a limited ability to discriminate and classify effectively. The PROBAST assessment indicated a high risk of systematic errors in predicted outcomes and artificial intelligence or machine learning applications. CONCLUSIONS The findings indicate that the development of this field is still in its early stages. This systematic review indicates that application of machine learning in perioperative medicine is still at an early stage. While many studies suggest potential utility, several key challenges must be first overcome before their introduction into clinical practice. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Pietro Arina
- Bloomsbury Institute of Intensive Care Medicine and Human Physiology and Performance Laboratory, Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, United Kingdom
| | - Maciej R. Kaczorek
- Wellcome/EPSRC Centre of Interventional and Surgical Sciences and Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Daniel A. Hofmaenner
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom; and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Walter Pisciotta
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Patricia Refinetti
- Human Physiology and Performance Laboratory, Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Evangelos B. Mazomenos
- Wellcome/EPSRC Centre of Interventional and Surgical Sciences and Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - John Whittle
- Human Physiology and Performance Laboratory, Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, United Kingdom
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Chen C, Chen B, Yang J, Li X, Peng X, Feng Y, Guo R, Zou F, Zhou S, Hei Z. Development and validation of a practical machine learning model to predict sepsis after liver transplantation. Ann Med 2023; 55:624-633. [PMID: 36790357 PMCID: PMC9937004 DOI: 10.1080/07853890.2023.2179104] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Postoperative sepsis is one of the main causes of mortality after liver transplantation (LT). Our study aimed to develop and validate a predictive model for postoperative sepsis within 7 d in LT recipients using machine learning (ML) technology. METHODS Data of 786 patients received LT from January 2015 to January 2020 was retrospectively extracted from the big data platform of Third Affiliated Hospital of Sun Yat-sen University. Seven ML models were developed to predict postoperative sepsis. The area under the receiver-operating curve (AUC), sensitivity, specificity, accuracy, and f1-score were evaluated as the model performances. The model with the best performance was validated in an independent dataset involving 118 adult LT cases from February 2020 to April 2021. The postoperative sepsis-associated outcomes were also explored in the study. RESULTS After excluding 109 patients according to the exclusion criteria, 677 patients underwent LT were finally included in the analysis. Among them, 216 (31.9%) were diagnosed with sepsis after LT, which were related to more perioperative complications, increased postoperative hospital stay and mortality after LT (all p < .05). Our results revealed that a larger volume of red blood cell infusion, ascitic removal, blood loss and gastric drainage, less volume of crystalloid infusion and urine, longer anesthesia time, higher level of preoperative TBIL were the top 8 important variables contributing to the prediction of post-LT sepsis. The Random Forest Classifier (RF) model showed the best overall performance to predict sepsis after LT among the seven ML models developed in the study, with an AUC of 0.731, an accuracy of 71.6%, the sensitivity of 62.1%, and specificity of 76.1% in the internal validation set, and a comparable AUC of 0.755 in the external validation set. CONCLUSIONS Our study enrolled eight pre- and intra-operative variables to develop an RF-based predictive model of post-LT sepsis to assist clinical decision-making procedure.
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Affiliation(s)
- Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bingcheng Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jing Yang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyue Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaorong Peng
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yawei Feng
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rongchang Guo
- Guangzhou AID Cloud Technology Co., LTD, Guangzhou, People's Republic of China
| | - Fengyuan Zou
- Guangzhou AID Cloud Technology Co., LTD, Guangzhou, People's Republic of China
| | - Shaoli Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Asfari A, Wolovits J, Gazit AZ, Abbas Q, Macfadyen AJ, Cooper DS, Futterman C, Penk JS, Kelly RB, Salvin JW, Borasino S, Zaccagni HJ. A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients. Crit Care Explor 2023; 5:e1013. [PMID: 38053749 PMCID: PMC10695536 DOI: 10.1097/cce.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Postoperative pediatric congenital heart patients are predisposed to develop low-cardiac output syndrome. Serum lactate (lactic acid [LA]) is a well-defined marker of inadequate systemic oxygen delivery. OBJECTIVES We hypothesized that a near real-time risk index calculated by a noninvasive predictive analytics algorithm predicts elevated LA in pediatric patients admitted to a cardiac ICU (CICU). DERIVATION COHORT Ten tertiary CICUs in the United States and Pakistan. VALIDATION COHORT Retrospective observational study performed to validate a hyperlactatemia (HLA) index using T3 platform data (Etiometry, Boston, MA) from pediatric patients less than or equal to 12 years of age admitted to CICU (n = 3,496) from January 1, 2018, to December 31, 2020. Patients lacking required data for module or LA measurements were excluded. PREDICTION MODEL Physiologic algorithm used to calculate an HLA index that incorporates physiologic data from patients in a CICU. The algorithm uses Bayes' theorem to interpret newly acquired data in a near real-time manner given its own previous assessment of the physiologic state of the patient. RESULTS A total of 58,168 LA measurements were obtained from 3,496 patients included in a validation dataset. HLA was defined as LA level greater than 4 mmol/L. Using receiver operating characteristic analysis and a complete dataset, the HLA index predicted HLA with high sensitivity and specificity (area under the curve 0.95). As the index value increased, the likelihood of having higher LA increased (p < 0.01). In the validation dataset, the relative risk of having LA greater than 4 mmol/L when the HLA index is less than 1 is 0.07 (95% CI: 0.06-0.08), and the relative risk of having LA less than 4 mmol/L when the HLA index greater than 99 is 0.13 (95% CI, 0.12-0.14). CONCLUSIONS These results validate the capacity of the HLA index. This novel index can provide a noninvasive prediction of elevated LA. The HLA index showed strong positive association with elevated LA levels, potentially providing bedside clinicians with an early, noninvasive warning of impaired cardiac output and oxygen delivery. Prospective studies are required to analyze the effect of this index on clinical decision-making and outcomes in pediatric population.
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Affiliation(s)
- Ahmed Asfari
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Wolovits
- Division of Critical Care, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Avihu Z Gazit
- Divisions of Critical Care and Cardiology, Department of Pediatrics, Washington University, St. Louis, MO
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Andrew J Macfadyen
- Division of Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| | - David S Cooper
- Division of Cardiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Craig Futterman
- Division of Critical Care, Department of Pediatrics, George Washington University, Washington, DC
| | - Jamie S Penk
- Division of Cardiology, Department of Pediatrics, Northwestern University, Chicago, IL
| | - Robert B Kelly
- Division of Critical Care, Children's Hospital of Orange County, Orange, CA
- Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, CA
| | - Joshua W Salvin
- Division of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Santiago Borasino
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Hayden J Zaccagni
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
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Cheng CY, Kung CT, Chen FC, Chiu IM, Lin CHR, Chu CC, Kung CF, Su CM. Machine learning models for predicting in-hospital mortality in patient with sepsis: Analysis of vital sign dynamics. Front Med (Lausanne) 2022; 9:964667. [PMID: 36341257 PMCID: PMC9631306 DOI: 10.3389/fmed.2022.964667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To build machine learning models for predicting the risk of in-hospital death in patients with sepsis within 48 h, using only dynamic changes in the patient's vital signs. Methods This retrospective observational cohort study enrolled septic patients from five emergency departments (ED) in Taiwan. We adopted seven variables, i.e., age, sex, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and body temperature. Results Among all 353,253 visits, after excluding 159,607 visits (45%), the study group consisted of 193,646 ED visits. With a leading time of 6 h, the convolutional neural networks (CNNs), long short-term memory (LSTM), and random forest (RF) had accuracy rates of 0.905, 0.817, and 0.835, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.840, 0.761, and 0.770, respectively. With a leading time of 48 h, the CNN, LSTM, and RF achieved accuracy rates of 0.828, 0759, and 0.805, respectively, and an AUC of 0.811, 0.734, and 0.776, respectively. Conclusion By analyzing dynamic vital sign data, machine learning models can predict mortality in septic patients within 6 to 48 h of admission. The performance of the testing models is more accurate if the lead time is closer to the event.
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Affiliation(s)
- Chi-Yung Cheng
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Cheng Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Min Chiu
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chun-Chieh Chu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien Feng Kung
- Graduate Institute and Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
- *Correspondence: Chien Feng Kung
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Chih-Min Su ;
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Evaluating machine learning models for sepsis prediction: A systematic review of methodologies. iScience 2022; 25:103651. [PMID: 35028534 PMCID: PMC8741489 DOI: 10.1016/j.isci.2021.103651] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022] Open
Abstract
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 the studies; (3.) the closer to the onset of sepsis, the higher the value of AUROC is; (4.) the improvement in AUROC is primarily due to using machine learning as a feature engineering tool; (5.) deep neural networks coupled with Sepsis-3 diagnostic criteria tend to yield better results on the time series data collected from patients with sepsis. The new evaluation criteria and reporting standards will facilitate the development of improved machine learning models for clinical applications. New evaluation/reporting standard for sepsis prediction machine learning models Major limitations in the current models for sepsis prediction have been identified We strongly suggest using machine learning as a feature engineering tool Recommending multilayer neural networks and Sepsis 3.0 for yield better result
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