Utilizing machine learning to improve clinical trial design for acute respiratory distress syndrome
| Autor: | Asif Rahman, Joseph J. Frassica, Hubert Truebel, Philip Boehme, Yale Chang, K. Jansson, E. Schwager, Minnan Xu-Wilson, Gregory Boverman, Brian David Gross, S. Schiffer |
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| Rok vydání: | 2021 |
| Předmět: |
ARDS
Multivariate statistics Computer applications to medicine. Medical informatics Population R858-859.7 Medicine (miscellaneous) Health Informatics Machine learning computer.software_genre law.invention Health Information Management law medicine education education.field_of_study Univariate analysis business.industry Clinical study design medicine.disease Intensive care unit Computer Science Applications Clinical trial Cohort Artificial intelligence business computer |
| Zdroj: | npj Digital Medicine, Vol 4, Iss 1, Pp 1-9 (2021) |
| ISSN: | 2398-6352 |
| DOI: | 10.1038/s41746-021-00505-5 |
| Popis: | Heterogeneous patient populations, complex pharmacology and low recruitment rates in the Intensive Care Unit (ICU) have led to the failure of many clinical trials. Recently, machine learning (ML) emerged as a new technology to process and identify big data relationships, enabling a new era in clinical trial design. In this study, we designed a ML model for predictively stratifying acute respiratory distress syndrome (ARDS) patients, ultimately reducing the required number of patients by increasing statistical power through cohort homogeneity. From the Philips eICU Research Institute (eRI) database, no less than 51,555 ARDS patients were extracted. We defined three subpopulations by outcome: (1) rapid death, (2) spontaneous recovery, and (3) long-stay patients. A retrospective univariate analysis identified highly predictive variables for each outcome. All 220 variables were used to determine the most accurate and generalizable model to predict long-stay patients. Multiclass gradient boosting was identified as the best-performing ML model. Whereas alterations in pH, bicarbonate or lactate proved to be strong predictors for rapid death in the univariate analysis, only the multivariate ML model was able to reliably differentiate the disease course of the long-stay outcome population (AUC of 0.77). We demonstrate the feasibility of prospective patient stratification using ML algorithms in the by far largest ARDS cohort reported to date. Our algorithm can identify patients with sufficiently long ARDS episodes to allow time for patients to respond to therapy, increasing statistical power. Further, early enrollment alerts may increase recruitment rate. |
| Databáze: | OpenAIRE |
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