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Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach
BACKGROUND AND AIM: Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for I...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099396/ https://www.ncbi.nlm.nih.gov/pubmed/36258306 http://dx.doi.org/10.1111/jgh.16029 |
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author | Charilaou, Paris Mohapatra, Sonmoon Doukas, Sotirios Kohli, Maanit Radadiya, Dhruvil Devani, Kalpit Broder, Arkady Elemento, Olivier Lukin, Dana J Battat, Robert |
author_facet | Charilaou, Paris Mohapatra, Sonmoon Doukas, Sotirios Kohli, Maanit Radadiya, Dhruvil Devani, Kalpit Broder, Arkady Elemento, Olivier Lukin, Dana J Battat, Robert |
author_sort | Charilaou, Paris |
collection | PubMed |
description | BACKGROUND AND AIM: Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for IM using machine‐learning (ML). METHODS: Using the National Inpatient Sample (NIS) database (2005–2017), we extracted adults admitted for IBD. After ML‐guided predictor selection, we trained and internally validated multiple algorithms, targeting minimum sensitivity and positive likelihood ratio (+LR) ≥ 80% and ≥ 3, respectively. Diagnostic odds ratio (DOR) compared algorithm performance. The best performing algorithm was additionally trained and validated for an IBD‐related surgery sub‐cohort. External validation was done using NIS 2018. RESULTS: In 398 426 adult IBD admissions, IM was 0.32% overall, and 0.87% among the surgical cohort (n = 40 784). Increasing age, ulcerative colitis, IBD‐related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock and thromboembolism were associated with increased IM. The QLattice algorithm, provided the highest performance model (+LR: 3.2, 95% CI 3.0–3.3; area‐under‐curve [AUC]:0.87, 85% sensitivity, 73% specificity), distinguishing IM patients by 15.6‐fold when comparing high to low‐risk patients. The surgical cohort model (+LR: 8.5, AUC: 0.94, 85% sensitivity, 90% specificity), distinguished IM patients by 49‐fold. Both models performed excellently in external validation. An online calculator (https://clinicalc.ai/im‐ibd/) was developed allowing bedside model predictions. CONCLUSIONS: An online prediction‐model calculator captured > 80% IM cases during IBD‐related admissions, with high discriminatory effectiveness. This allows for risk stratification and provides a basis for assessing interventions to reduce mortality in high‐risk patients. |
format | Online Article Text |
id | pubmed-10099396 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100993962023-04-14 Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach Charilaou, Paris Mohapatra, Sonmoon Doukas, Sotirios Kohli, Maanit Radadiya, Dhruvil Devani, Kalpit Broder, Arkady Elemento, Olivier Lukin, Dana J Battat, Robert J Gastroenterol Hepatol Original Articles ‐ Gastroenterology (Clinical) BACKGROUND AND AIM: Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for IM using machine‐learning (ML). METHODS: Using the National Inpatient Sample (NIS) database (2005–2017), we extracted adults admitted for IBD. After ML‐guided predictor selection, we trained and internally validated multiple algorithms, targeting minimum sensitivity and positive likelihood ratio (+LR) ≥ 80% and ≥ 3, respectively. Diagnostic odds ratio (DOR) compared algorithm performance. The best performing algorithm was additionally trained and validated for an IBD‐related surgery sub‐cohort. External validation was done using NIS 2018. RESULTS: In 398 426 adult IBD admissions, IM was 0.32% overall, and 0.87% among the surgical cohort (n = 40 784). Increasing age, ulcerative colitis, IBD‐related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock and thromboembolism were associated with increased IM. The QLattice algorithm, provided the highest performance model (+LR: 3.2, 95% CI 3.0–3.3; area‐under‐curve [AUC]:0.87, 85% sensitivity, 73% specificity), distinguishing IM patients by 15.6‐fold when comparing high to low‐risk patients. The surgical cohort model (+LR: 8.5, AUC: 0.94, 85% sensitivity, 90% specificity), distinguished IM patients by 49‐fold. Both models performed excellently in external validation. An online calculator (https://clinicalc.ai/im‐ibd/) was developed allowing bedside model predictions. CONCLUSIONS: An online prediction‐model calculator captured > 80% IM cases during IBD‐related admissions, with high discriminatory effectiveness. This allows for risk stratification and provides a basis for assessing interventions to reduce mortality in high‐risk patients. John Wiley and Sons Inc. 2022-11-18 2023-02 /pmc/articles/PMC10099396/ /pubmed/36258306 http://dx.doi.org/10.1111/jgh.16029 Text en © 2022 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles ‐ Gastroenterology (Clinical) Charilaou, Paris Mohapatra, Sonmoon Doukas, Sotirios Kohli, Maanit Radadiya, Dhruvil Devani, Kalpit Broder, Arkady Elemento, Olivier Lukin, Dana J Battat, Robert Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach |
title | Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach |
title_full | Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach |
title_fullStr | Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach |
title_full_unstemmed | Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach |
title_short | Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach |
title_sort | predicting inpatient mortality in patients with inflammatory bowel disease: a machine learning approach |
topic | Original Articles ‐ Gastroenterology (Clinical) |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099396/ https://www.ncbi.nlm.nih.gov/pubmed/36258306 http://dx.doi.org/10.1111/jgh.16029 |
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