Short-term prediction of low kidney function in ICU patients

Intensive care treatment presents unique challenges in the medical world. When treating patients, their wide variety leave care providers with few past examples to draw on. Instead of operating in a pure knowledge discovery capacity, decision support systems can be developed to help predict short-term and long-term patient outcome, based upon available data. One area in which generalized severity scoring systems have consistently performed poorly is among patients admitted intensive care units (ICU) who then develop acute kidney injury. Urine output is used to guide fluid resuscitation and is one of the criteria for the diagnosis of acute kidney injury. This paper provides an example application for predicting short-term critical kidney function in an intensive care unit. Feature construction is performed to extract important aspects of the clinical evolution of the patient. Feature selection is performed on several patient features. Classifiers based on support vector machines and Takagi-Sugeno fuzzy models are developed to predict short-term drops in patient urine output rate. Both types of models showed comparable results, with an AUC of 78%. This shows potential in using similar classifiers to build an ICU decision support system with the goal of predicting short-term complication in the patient and augment current guidelines by anticipating treatment.

[1]  Yask Patel,et al.  Clinical Decision Support Systems , 2019 .

[2]  Stephan M. Jakob,et al.  Arterial blood pressure during early sepsis and outcome , 2009, Intensive Care Medicine.

[3]  João Miguel da Costa Sousa,et al.  Decision tree search methods in fuzzy modeling and classification , 2007, Int. J. Approx. Reason..

[4]  Simon Haykin,et al.  Neural Networks and Learning Machines , 2010 .

[5]  M. Nanni,et al.  Spatio-Temporal Clustering : a Survey Spatio-Temporal Clustering : a Survey , 2010 .

[6]  João Miguel da Costa Sousa,et al.  Missing data in medical databases: Impute, delete or classify? , 2013, Artif. Intell. Medicine.

[7]  Viju Raghupathi,et al.  Big data analytics in healthcare: promise and potential , 2014, Health Information Science and Systems.

[8]  Donald Gustafson,et al.  Fuzzy clustering with a fuzzy covariance matrix , 1978, 1978 IEEE Conference on Decision and Control including the 17th Symposium on Adaptive Processes.

[9]  F. Collins,et al.  A new initiative on precision medicine. , 2015, The New England journal of medicine.

[10]  Geoffrey J. Gordon,et al.  Artificial intelligence in medicine , 1989, Singapore medical journal.

[11]  Richard L Kravitz,et al.  Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. , 2004, The Milbank quarterly.

[12]  L. Celi,et al.  A Clinical Database-Driven Approach to Decision Support: Predicting Mortality Among Patients with Acute Kidney Injury. , 2011, Journal of healthcare engineering.

[13]  L. Tarassenko,et al.  Dynamic Data During Hypotensive Episode Improves Mortality Predictions Among Patients With Sepsis and Hypotension* , 2013, Critical care medicine.

[14]  Peter Szolovits,et al.  MIMIC-III, a freely accessible critical care database , 2016, Scientific Data.

[15]  Uzay Kaymak,et al.  Fuzzy Decision Making in Modeling and Control , 2002, World Scientific Series in Robotics and Intelligent Systems.

[16]  Tom Fawcett,et al.  An introduction to ROC analysis , 2006, Pattern Recognit. Lett..

[17]  Michio Sugeno,et al.  Fuzzy identification of systems and its applications to modeling and control , 1985, IEEE Transactions on Systems, Man, and Cybernetics.

[18]  W. Marsden I and J , 2012 .

[19]  Susana M. Vieira,et al.  Fuzzy Modeling to Predict Severely Depressed Left Ventricular Ejection Fraction following Admission to the Intensive Care Unit Using Clinical Physiology , 2015, TheScientificWorldJournal.

[20]  Michael J. Fine,et al.  How to derive and validate clinical prediction models for use in intensive care medicine , 2014, Intensive Care Medicine.

[21]  E. Mizutani,et al.  Neuro-Fuzzy and Soft Computing-A Computational Approach to Learning and Machine Intelligence [Book Review] , 1997, IEEE Transactions on Automatic Control.