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Development and validation of high definition phenotype-based mortality prediction in critical care units

OBJECTIVES: The objectives of this study are to construct the high definition phenotype (HDP), a novel time-series data structure composed of both primary and derived parameters, using heterogeneous clinical sources and to determine whether different predictive models can utilize the HDP in the neon...

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Autores principales: Sun, Yao, Kaur, Ravneet, Gupta, Shubham, Paul, Rahul, Das, Ritu, Cho, Su Jin, Anand, Saket, Boutilier, Justin J, Saria, Suchi, Palma, Jonathan, Saluja, Satish, McAdams, Ryan M, Kaur, Avneet, Yadav, Gautam, Singh, Harpreet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991779/
https://www.ncbi.nlm.nih.gov/pubmed/33796821
http://dx.doi.org/10.1093/jamiaopen/ooab004
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author Sun, Yao
Kaur, Ravneet
Gupta, Shubham
Paul, Rahul
Das, Ritu
Cho, Su Jin
Anand, Saket
Boutilier, Justin J
Saria, Suchi
Palma, Jonathan
Saluja, Satish
McAdams, Ryan M
Kaur, Avneet
Yadav, Gautam
Singh, Harpreet
author_facet Sun, Yao
Kaur, Ravneet
Gupta, Shubham
Paul, Rahul
Das, Ritu
Cho, Su Jin
Anand, Saket
Boutilier, Justin J
Saria, Suchi
Palma, Jonathan
Saluja, Satish
McAdams, Ryan M
Kaur, Avneet
Yadav, Gautam
Singh, Harpreet
author_sort Sun, Yao
collection PubMed
description OBJECTIVES: The objectives of this study are to construct the high definition phenotype (HDP), a novel time-series data structure composed of both primary and derived parameters, using heterogeneous clinical sources and to determine whether different predictive models can utilize the HDP in the neonatal intensive care unit (NICU) to improve neonatal mortality prediction in clinical settings. MATERIALS AND METHODS: A total of 49 primary data parameters were collected from July 2018 to May 2020 from eight level-III NICUs. From a total of 1546 patients, 757 patients were found to contain sufficient fixed, intermittent, and continuous data to create HDPs. Two different predictive models utilizing the HDP, one a logistic regression model (LRM) and the other a deep learning long–short-term memory (LSTM) model, were constructed to predict neonatal mortality at multiple time points during the patient hospitalization. The results were compared with previous illness severity scores, including SNAPPE, SNAPPE-II, CRIB, and CRIB-II. RESULTS: A HDP matrix, including 12 221 536 minutes of patient stay in NICU, was constructed. The LRM model and the LSTM model performed better than existing neonatal illness severity scores in predicting mortality using the area under the receiver operating characteristic curve (AUC) metric. An ablation study showed that utilizing continuous parameters alone results in an AUC score of >80% for both LRM and LSTM, but combining fixed, intermittent, and continuous parameters in the HDP results in scores >85%. The probability of mortality predictive score has recall and precision of 0.88 and 0.77 for the LRM and 0.97 and 0.85 for the LSTM. CONCLUSIONS AND RELEVANCE: The HDP data structure supports multiple analytic techniques, including the statistical LRM approach and the machine learning LSTM approach used in this study. LRM and LSTM predictive models of neonatal mortality utilizing the HDP performed better than existing neonatal illness severity scores. Further research is necessary to create HDP–based clinical decision tools to detect the early onset of neonatal morbidities.
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spelling pubmed-79917792021-03-31 Development and validation of high definition phenotype-based mortality prediction in critical care units Sun, Yao Kaur, Ravneet Gupta, Shubham Paul, Rahul Das, Ritu Cho, Su Jin Anand, Saket Boutilier, Justin J Saria, Suchi Palma, Jonathan Saluja, Satish McAdams, Ryan M Kaur, Avneet Yadav, Gautam Singh, Harpreet JAMIA Open Research and Applications OBJECTIVES: The objectives of this study are to construct the high definition phenotype (HDP), a novel time-series data structure composed of both primary and derived parameters, using heterogeneous clinical sources and to determine whether different predictive models can utilize the HDP in the neonatal intensive care unit (NICU) to improve neonatal mortality prediction in clinical settings. MATERIALS AND METHODS: A total of 49 primary data parameters were collected from July 2018 to May 2020 from eight level-III NICUs. From a total of 1546 patients, 757 patients were found to contain sufficient fixed, intermittent, and continuous data to create HDPs. Two different predictive models utilizing the HDP, one a logistic regression model (LRM) and the other a deep learning long–short-term memory (LSTM) model, were constructed to predict neonatal mortality at multiple time points during the patient hospitalization. The results were compared with previous illness severity scores, including SNAPPE, SNAPPE-II, CRIB, and CRIB-II. RESULTS: A HDP matrix, including 12 221 536 minutes of patient stay in NICU, was constructed. The LRM model and the LSTM model performed better than existing neonatal illness severity scores in predicting mortality using the area under the receiver operating characteristic curve (AUC) metric. An ablation study showed that utilizing continuous parameters alone results in an AUC score of >80% for both LRM and LSTM, but combining fixed, intermittent, and continuous parameters in the HDP results in scores >85%. The probability of mortality predictive score has recall and precision of 0.88 and 0.77 for the LRM and 0.97 and 0.85 for the LSTM. CONCLUSIONS AND RELEVANCE: The HDP data structure supports multiple analytic techniques, including the statistical LRM approach and the machine learning LSTM approach used in this study. LRM and LSTM predictive models of neonatal mortality utilizing the HDP performed better than existing neonatal illness severity scores. Further research is necessary to create HDP–based clinical decision tools to detect the early onset of neonatal morbidities. Oxford University Press 2021-03-25 /pmc/articles/PMC7991779/ /pubmed/33796821 http://dx.doi.org/10.1093/jamiaopen/ooab004 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Research and Applications
Sun, Yao
Kaur, Ravneet
Gupta, Shubham
Paul, Rahul
Das, Ritu
Cho, Su Jin
Anand, Saket
Boutilier, Justin J
Saria, Suchi
Palma, Jonathan
Saluja, Satish
McAdams, Ryan M
Kaur, Avneet
Yadav, Gautam
Singh, Harpreet
Development and validation of high definition phenotype-based mortality prediction in critical care units
title Development and validation of high definition phenotype-based mortality prediction in critical care units
title_full Development and validation of high definition phenotype-based mortality prediction in critical care units
title_fullStr Development and validation of high definition phenotype-based mortality prediction in critical care units
title_full_unstemmed Development and validation of high definition phenotype-based mortality prediction in critical care units
title_short Development and validation of high definition phenotype-based mortality prediction in critical care units
title_sort development and validation of high definition phenotype-based mortality prediction in critical care units
topic Research and Applications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991779/
https://www.ncbi.nlm.nih.gov/pubmed/33796821
http://dx.doi.org/10.1093/jamiaopen/ooab004
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