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Original article
Available online 30 August 2024
Application of a machine learning model for early prediction of in-hospital cardiac arrests: Retrospective observational cohort study
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L. Socias Crespía,b,c,
Corresponding author
lsocias@hsll.es

Corresponding author.
, L. Gutiérrez Madroñala,b,d, M. Fiorella Sarubbod,f, M. Borges-Saa,b, A. Serrano Garcíae, D. López Ramose, C. Pruenza Garcia-Hinojosae, E. Martin Garijoe
a Intensive Care Department, Son Llàtzer University Hospital, Crta. Manacor Km 4, 07198, Palma, Spain
b Department of Medicine, Faculty of Medicine, University of the Balearic Islands, Crta. Valldemossa Km. 7.5, Palma, Spain
c Group of Critic Patient, Health Research Institute of the Balearic Islands (IdISBa), 07198, Palma, Spain
d Research Unit, Son Llàtzer University Hospital, Crta. Manacor Km 4, 07198, Palma, Spain
e Knowledge Engineering Institute, Universidad Autónoma de Madrid, Madrid, Spain
f Department of Biology, Faculty of Science, University of the Balearic Islands, Crta. Valldemossa Km. 7.5, Palma, Spain
This item has received
Received 12 February 2024. Accepted 27 June 2024
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Figures (1)
Tables (3)
Table 1. Comparison of baseline characteristics between the train and test cohorts.
Table 2. Summary characteristics of the binary predictor variables.
Table 3. Metrics obtained by the different ML models and the reference model, MEWS. The results are the averages (in %, with Confidence Intervals at 95%) across the four splits in the cross-validation.
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Additional material (1)
Abstract
Objective

To describe the results of the application of a Machine Learning (ML) model to predict in-hospital cardiac arrests (ICA) 24 hours in advance in the hospital wards.

Design

Retrospective observational cohort study.

Setting

Hospital Wards.

Patients

Data were extracted from the hospital's Electronic Health Record (EHR). The resulting database contained a total of 750 records corresponding to 620 different patients (370 patients with ICA and 250 control), between may 2009 and december 2021.

Interventions

No.

Main variables of interest

As predictors of ICA, a set of 28 variables including personal history, vital signs and laboratory data was employed.

Models

For the early prediction of ICA, predictive models based on the following ML algorithms and using the mentioned variables, were developed and compared: K Nearest Neighbours, Support Vector Machine, Multilayer Perceptron, Random Forest, Gradient Boosting and Custom Ensemble of Gradient Boosting estimators (CEGB).

Experiments

Model training and evaluation was carried out using cross validation. Among metrics of performance, accuracy, specificity, sensitivity and AUC were estimated.

Results

The best performance was provided by the CEGB model, which obtained an AUC = 0.90, a specificity = 0.84 and a sensitivity = 0.81. The main variables with influence to predict ICA were level of consciousness, haemoglobin, glucose, urea, blood pressure, heart rate, creatinine, age and hypertension, among others.

Conclusions

The use of ML models could be of great support in the early detection of ICA, as the case of the CEGB model endorsed, which enabled good predictions of ICA.

Keywords:
In-hospital cardiac arrest
Heart arrest
Machine learning
Artificial intelligence
Intensive Care Unit
Critical care
Big Data
Diagnosis
Prognosis
Prevention
Abbreviations:
AUC
ATH
BDA
CEGB
COPD
CV
EHR
GB
HR
ICA
ICU
ICT
IHD
KNN
LC
ML
MLP
RF
RR
SBP
SHAP
SO2
SVM

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