Advancing prognostic precision in pulmonary embolism: A clinical and laboratory-based artificial intelligence approach for enhanced early mortality risk stratification

BACKGROUND

Acute pulmonary embolism (PE) is a critical medical emergency that necessitates prompt identification and intervention. Accurate prognostication of early mortality is vital for recognizing patients at elevated risk for unfavourable outcomes and administering suitable therapy. Machine learning (ML) algorithms hold promise for enhancing the precision of early mortality prediction in PE patients.

OBJECTIVE

To devise an ML algorithm for early mortality prediction in PE patients by employing clinical and laboratory variables.

METHODS

This study utilized diverse oversampling techniques to improve the performance of various machine learning models including ANN, SVM, DT, RF, and AdaBoost for early mortality prediction. Appropriate oversampling methods were chosen for each model based on algorithm characteristics and dataset properties. Predictor variables included four lab tests, eight physiological time series indicators, and two general descriptors. Evaluation used metrics like accuracy, F1_score, precision, recall, Area Under the Curve (AUC) and Receiver Operating Characteristic (ROC) curves, providing a comprehensive view of models' predictive abilities.

RESULTS

The findings indicated that the RF model with random oversampling exhibited superior performance among the five models assessed, achieving elevated accuracy and precision alongside high recall for predicting the death class. The oversampling approaches effectively equalized the sample distribution among the classes and enhanced the models' performance.

CONCLUSIONS

The suggested ML technique can efficiently prognosticate mortality in patients afflicted with acute PE. The RF model with random oversampling can aid healthcare professionals in making well-informed decisions regarding the treatment of patients with acute PE. The study underscores the significance of oversampling methods in managing imbalanced data and emphasizes the potential of ML algorithms in refining early mortality prediction for PE patients.

A machine learning approach for mortality prediction only using non-invasive parameters

At present, the traditional scoring methods generally utilize laboratory measurements to predict mortality. It results in difficulties of early mortality prediction in the rural areas lack of professional laboratorians and medical laboratory equipment. To improve the efficiency, accuracy, and applicability of mortality prediction in the remote areas, a novel mortality prediction method based on machine learning algorithms is proposed, which only uses non-invasive parameters readily available from ordinary monitors and manual measurement. A new feature selection method based on the Bayes error rate is developed to select valuable features. Based on non-invasive parameters, four machine learning models were trained for early mortality prediction. The subjects contained in this study suffered from general critical diseases including but not limited to cancer, bone fracture, and diarrhea. Comparison tests among five traditional scoring methods and these four machine learning models with and without laboratory measurement variables are performed. Only using the non-invasive parameters, the LightGBM algorithms have an excellent performance with the largest accuracy of 0.797 and AUC of 0.879. There is no apparent difference between the mortality prediction performance with and without laboratory measurement variables for the four machine learning methods. After reducing the number of feature variables to no more than 50, the machine learning models still outperform the traditional scoring systems, with AUC higher than 0.83. The machine learning approaches only using non-invasive parameters achieved an excellent mortality prediction performance and can equal those using extra laboratory measurements, which can be applied in rural areas and remote battlefield for mortality risk evaluation. Graphical abstract.