Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy

• Published in: PloS one 2014-02, Vol.9 (2), p.e88225-e88225
• Main Authors: Asadi, Hamed, Dowling, Richard, Yan, Bernard, Mitchell, Peter
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Artificial Intelligence; Artificial neural networks; Blood; Brain Ischemia - etiology; Brain Ischemia - therapy; Cardiovascular system; Care and treatment; Computer Science; Data mining; Demographics; Endovascular Procedures - adverse effects; FDA approval; Female; Humans; International cooperation; Intervention; Intracranial Hemorrhages - pathology; Ischemia; Learning algorithms; Machine learning; Male; Medical prognosis; Medical research; Medical treatment; Medicine; Models, Theoretical; Morbidity; Neural networks; Neural Networks (Computer); Patients; Predictions; Prognosis; Regression analysis; Regression models; Risk groups; ROC Curve; Stroke; Stroke - etiology; Stroke - therapy; Stroke patients; Studies; Success; Support Vector Machine; Treatment Outcome; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0088225

Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408). We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter datasets, likely further improving prediction. Finally, we propose that a robust machine learning system can potentially optimise the selection process for endovascular versus medical treatment in the management of acute stroke.