Using a machine learning approach to predict mortality in critically ill influenza patients: A cross-sectional retrospective multicentre study in Taiwan
Journal
BMJ Open
Journal Volume
10
Journal Issue
2
Pages
e033898
Date Issued
2020
Author(s)
Hu C.-A.
Chen C.-M.
Fang Y.-C.
Liang S.-J.
Fang W.-F.
Sheu C.-C.
Perng W.-C.
Yang K.-Y.
Kao K.-C.
Wu C.-L.
Tsai C.-S.
Lin M.-Y.
Chao W.-C.
Abstract
Current mortality prediction models used in the intensive care unit (ICU) have a limited role for specific diseases such as influenza, and we aimed to establish an explainable machine learning (ML) model for predicting mortality in critically ill influenza patients using a real-world severe influenza data set. Study design A cross-sectional retrospective multicentre study in Taiwan Setting Eight medical centres in Taiwan. Participants A total of 336 patients requiring ICU-admission for virology-proven influenza at eight hospitals during an influenza epidemic between October 2015 and March 2016. Primary and secondary outcome measures We employed extreme gradient boosting (XGBoost) to establish the prediction model, compared the performance with logistic regression (LR) and random forest (RF), demonstrated the feature importance categorised by clinical domains, and used SHapley Additive exPlanations (SHAP) for visualised interpretation. Results The data set contained 76 features of the 336 patients with severe influenza. The severity was apparently high, as shown by the high Acute Physiology and Chronic Health Evaluation II score (22, 17 to 29) and pneumonia severity index score (118, 88 to 151). XGBoost model (area under the curve (AUC): 0.842; 95% CI 0.749 to 0.928) outperformed RF (AUC: 0.809; 95% CI 0.629 to 0.891) and LR (AUC: 0.701; 95% CI 0.573 to 0.825) for predicting 30-day mortality. To give clinicians an intuitive understanding of feature exploitation, we stratified features by the clinical domain. The cumulative feature importance in the fluid balance domain, ventilation domain, laboratory data domain, demographic and symptom domain, management domain and severity score domain was 0.253, 0.113, 0.177, 0.140, 0.152 and 0.165, respectively. We further used SHAP plots to illustrate associations between features and 30-day mortality in critically ill influenza patients. Conclusions We used a real-world data set and applied an ML approach, mainly XGBoost, to establish a practical and explainable mortality prediction model in critically ill influenza patients. ? Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Subjects
adult intensive & critical care; adult intensive & critical care; infectious diseases & infestations; information technology; thoracic medicine
SDGs
Other Subjects
hypertensive factor; oseltamivir; steroid; adult; aged; APACHE; Article; comorbidity; critically ill patient; cross-sectional study; demography; disease severity; extracorporeal oxygenation; female; fluid balance; hemodialysis; human; infection complication; influenza; intensive care unit; laboratory test; logistic regression analysis; lung ventilation; machine learning; major clinical study; male; mortality; mortality rate; outcome assessment; Pneumonia Severity Index; positive end expiratory pressure; prediction; random forest; real time polymerase chain reaction; retrospective study; sedation; survival prediction; symptom; Taiwan; virus culture; critical illness; hospital mortality; influenza; middle aged; theoretical model; Adult; Critical Illness; Cross-Sectional Studies; Female; Hospital Mortality; Humans; Influenza, Human; Machine Learning; Male; Middle Aged; Models, Theoretical; Outcome Assessment, Health Care; Retrospective Studies; Taiwan
Publisher
BMJ Publishing Group
Type
journal article