An intelligent warning model for early prediction of cardiac arrest in sepsis patients

• Published in: Computer methods and programs in biomedicine 2019-09, Vol.178, p.47-58
• Main Authors: Layeghian Javan, Samaneh, Sepehri, Mohammad Mehdi, Layeghian Javan, Malihe, Khatibi, Toktam
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Algorithms; APACHE; Case-Control Studies; Decision Trees; Electronic Health Records; Female; Heart arrest; Heart Arrest - complications; Heart Arrest - diagnosis; Heart Arrest - epidemiology; Humans; Incidence; Intelligent warning model; Machine Learning; Male; Middle Aged; Monitoring, Ambulatory - methods; Multivariate Analysis; Normal Distribution; Prediction; Reproducibility of Results; Sensitivity and Specificity; Sepsis; Sepsis - complications; Sepsis - physiopathology; Severity of Illness Index; Vital Signs; Young Adult
• ISSN: 0169-2607; 1872-7565
• DOI: 10.1016/j.cmpb.2019.06.010

•The effectiveness of a wide range of classical and ensemble machine learning techniques in predicting cardiac arrest were evaluated through a systematic approach.•Patient's time series dynamics of vital signs was investigated as a new factor for predicting cardiac arrest.•Cardiac arrest incidence was predicted in several time intervals.•The proposed model generated better results compared with APACHE II and MEWS. Sepsis-associated cardiac arrest is a common issue with the low survival rate. Early prediction of cardiac arrest can provide the time required for intervening and preventing its onset in order to reduce mortality. Several studies have been conducted to predict cardiac arrest using machine learning. However, no previous research has used machine learning for predicting cardiac arrest in adult sepsis patients. Moreover, the potential of some techniques, including ensemble algorithms, has not yet been addressed in improving the prediction outcomes. It is required to find methods for generating high-performance predictions with sufficient time lapse before the arrest. In this regard, various variables and parameters should also been examined. The aim was to use machine learning in order to propose a cardiac arrest prediction model for adult patients with sepsis. It is required to predict the arrest several hours before the incidence with high efficiency. The other goal was to investigate the effect of the time series dynamics of vital signs on the prediction of cardiac arrest. 30 h clinical data of every sepsis patients were extracted from Mimic III database (79 cases, 4532 controls). Three datasets (multivariate, time series and combined) were created. Various machine learning models for six time groups were trained on these datasets. The models included classical techniques (SVM, decision tree, logistic regression, KNN, GaussianNB) and ensemble methods (gradient Boosting, XGBoost, random forest, balanced bagging classifier and stacking). Proper solutions were proposed to address the challenges of missing values, imbalanced classes of data and irregularity of time series. The best results were obtained using a stacking algorithm and multivariate dataset (accuracy = 0.76, precision = 0.19, sensitivity = 0.77, f1-score = 0.31, AUC= 0.82). The proposed model predicts the arrest incidence of up to six hours earlier with the accuracy and sensitivity over 70%. We illustrated that machine learning techniques, especially ensemble algorithms have high poten