Prediction of Acute Kidney Injury With a Machine Learning Algorithm Using Electronic Health Record Data

BACKGROUND: A major problem in treating acute kidney injury (AKI) is that clinical criteria for recognition are markers of established kidney damage or impaired function; treatment before such damage manifests is desirable. Clinicians could intervene during what may be a crucial stage for preventing permanent kidney injury if patients with incipient AKI and those at high risk of developing AKI could be identified. OBJECTIVE: In this study, we evaluate a machine learning algorithm for early detection and prediction of AKI. DESIGN: We used a machine learning technique, boosted ensembles of decision trees, to train an AKI prediction tool on retrospective data taken from more than 300 000 inpatient encounters. SETTING: Data were collected from inpatient wards at Stanford Medical Center and intensive care unit patients at Beth Israel Deaconess Medical Center. PATIENTS: Patients older than the age of 18 whose hospital stays lasted between 5 and 1000 hours and who had at least one documented measurement of heart rate, respiratory rate, temperature, serum creatinine (SCr), and Glasgow Coma Scale (GCS). MEASUREMENTS: We tested the algorithm’s ability to detect AKI at onset and to predict AKI 12, 24, 48, and 72 hours before onset. METHODS: We tested AKI detection and prediction using the National Health Service (NHS) England AKI Algorithm as a gold standard. We additionally tested the algorithm’s ability to detect AKI as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We compared the algorithm’s 3-fold cross-validation performance to the Sequential Organ Failure Assessment (SOFA) score for AKI identification in terms of area under the receiver operating characteristic (AUROC). RESULTS: The algorithm demonstrated high AUROC for detecting and predicting NHS-defined AKI at all tested time points. The algorithm achieves AUROC of 0.872 (95% confidence interval [CI], 0.867-0.878) for AKI detection at time of onset. For prediction 12 hours before onset, the algorithm achieves an AUROC of 0.800 (95% CI, 0.792-0.809). For 24-hour predictions, the algorithm achieves AUROC of 0.795 (95% CI, 0.785-0.804). For 48-hour and 72-hour predictions, the algorithm achieves AUROC values of 0.761 (95% CI, 0.753-0.768) and 0.728 (95% CI, 0.719-0.737), respectively. LIMITATIONS: Because of the retrospective nature of this study, we cannot draw any conclusions about the impact the algorithm’s predictions will have on patient outcomes in a clinical setting. CONCLUSIONS: The results of these experiments suggest that a machine learning–based AKI prediction tool may offer important prognostic capabilities for determining which patients are likely to suffer AKI, potentially allowing clinicians to intervene before kidney damage manifests.