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Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients
Frequent assessment of the severity of illness for hospitalized patients is essential in clinical settings to prevent outcomes such as in-hospital mortality and unplanned admission to the intensive care unit (ICU). Classical severity scores have been developed typically using relatively few patient...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10256150/ https://www.ncbi.nlm.nih.gov/pubmed/37294826 http://dx.doi.org/10.1371/journal.pdig.0000116 |
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author | Placido, Davide Thorsen-Meyer, Hans-Christian Kaas-Hansen, Benjamin Skov Reguant, Roc Brunak, Søren |
author_facet | Placido, Davide Thorsen-Meyer, Hans-Christian Kaas-Hansen, Benjamin Skov Reguant, Roc Brunak, Søren |
author_sort | Placido, Davide |
collection | PubMed |
description | Frequent assessment of the severity of illness for hospitalized patients is essential in clinical settings to prevent outcomes such as in-hospital mortality and unplanned admission to the intensive care unit (ICU). Classical severity scores have been developed typically using relatively few patient features. Recently, deep learning-based models demonstrated better individualized risk assessments compared to classic risk scores, thanks to the use of aggregated and more heterogeneous data sources for dynamic risk prediction. We investigated to what extent deep learning methods can capture patterns of longitudinal change in health status using time-stamped data from electronic health records. We developed a deep learning model based on embedded text from multiple data sources and recurrent neural networks to predict the risk of the composite outcome of unplanned ICU transfer and in-hospital death. The risk was assessed at regular intervals during the admission for different prediction windows. Input data included medical history, biochemical measurements, and clinical notes from a total of 852,620 patients admitted to non-intensive care units in 12 hospitals in Denmark’s Capital Region and Region Zealand during 2011–2016 (with a total of 2,241,849 admissions). We subsequently explained the model using the Shapley algorithm, which provides the contribution of each feature to the model outcome. The best model used all data modalities with an assessment rate of 6 hours, a prediction window of 14 days and an area under the receiver operating characteristic curve of 0.898. The discrimination and calibration obtained with this model make it a viable clinical support tool to detect patients at higher risk of clinical deterioration, providing clinicians insights into both actionable and non-actionable patient features. |
format | Online Article Text |
id | pubmed-10256150 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-102561502023-06-10 Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients Placido, Davide Thorsen-Meyer, Hans-Christian Kaas-Hansen, Benjamin Skov Reguant, Roc Brunak, Søren PLOS Digit Health Research Article Frequent assessment of the severity of illness for hospitalized patients is essential in clinical settings to prevent outcomes such as in-hospital mortality and unplanned admission to the intensive care unit (ICU). Classical severity scores have been developed typically using relatively few patient features. Recently, deep learning-based models demonstrated better individualized risk assessments compared to classic risk scores, thanks to the use of aggregated and more heterogeneous data sources for dynamic risk prediction. We investigated to what extent deep learning methods can capture patterns of longitudinal change in health status using time-stamped data from electronic health records. We developed a deep learning model based on embedded text from multiple data sources and recurrent neural networks to predict the risk of the composite outcome of unplanned ICU transfer and in-hospital death. The risk was assessed at regular intervals during the admission for different prediction windows. Input data included medical history, biochemical measurements, and clinical notes from a total of 852,620 patients admitted to non-intensive care units in 12 hospitals in Denmark’s Capital Region and Region Zealand during 2011–2016 (with a total of 2,241,849 admissions). We subsequently explained the model using the Shapley algorithm, which provides the contribution of each feature to the model outcome. The best model used all data modalities with an assessment rate of 6 hours, a prediction window of 14 days and an area under the receiver operating characteristic curve of 0.898. The discrimination and calibration obtained with this model make it a viable clinical support tool to detect patients at higher risk of clinical deterioration, providing clinicians insights into both actionable and non-actionable patient features. Public Library of Science 2023-06-09 /pmc/articles/PMC10256150/ /pubmed/37294826 http://dx.doi.org/10.1371/journal.pdig.0000116 Text en © 2023 Placido et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Placido, Davide Thorsen-Meyer, Hans-Christian Kaas-Hansen, Benjamin Skov Reguant, Roc Brunak, Søren Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients |
title | Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients |
title_full | Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients |
title_fullStr | Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients |
title_full_unstemmed | Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients |
title_short | Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients |
title_sort | development of a dynamic prediction model for unplanned icu admission and mortality in hospitalized patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10256150/ https://www.ncbi.nlm.nih.gov/pubmed/37294826 http://dx.doi.org/10.1371/journal.pdig.0000116 |
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