Development and Validation of a Machine Learning Model for Early Detection of Untreated Infection

Autor: Kevin G. Buell, MBBS, MS, Kyle A. Carey, MPH, Nicole Dussault, MD, William F. Parker, MD, PhD, Jay Dumanian, MD, Sivasubramanium V. Bhavani, MD, MS, Emily R. Gilbert, MD, Christopher J. Winslow, MD, Nirav S. Shah, MD, MPH, Majid Afshar, MD, MSCR, Dana P. Edelson, MD, MS, Matthew M. Churpek, MD, MPH, PhD
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Critical Care Explorations, Vol 6, Iss 10, p e1165 (2024)
Druh dokumentu: article
ISSN: 2639-8028
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DOI: 10.1097/CCE.0000000000001165
Popis: BACKGROUND:. Early diagnostic uncertainty for infection causes delays in antibiotic administration in infected patients and unnecessary antibiotic administration in noninfected patients. OBJECTIVE:. To develop a machine learning model for the early detection of untreated infection (eDENTIFI), with the presence of infection determined by clinician chart review. DERIVATION COHORT:. Three thousand three hundred fifty-seven adult patients hospitalized between 2006 and 2018 at two health systems in Illinois, United States. VALIDATION COHORT:. We validated in 1632 patients in a third Illinois health system using area under the receiver operating characteristic curve (AUC). PREDICTION MODEL:. Using a longitudinal discrete-time format, we trained a gradient boosted machine model to predict untreated infection in the next 6 hours using routinely available patient demographics, vital signs, and laboratory results. RESULTS:. eDENTIFI had an AUC of 0.80 (95% CI, 0.79–0.81) in the validation cohort and outperformed the systemic inflammatory response syndrome criteria with an AUC of 0.64 (95% CI, 0.64–0.65; p < 0.001). The most important features were body mass index, age, temperature, and heart rate. Using a threshold with a 47.6% sensitivity, eDENTIFI detected infection a median 2.0 hours (interquartile range, 0.9–5.2 hr) before antimicrobial administration, with a negative predictive value of 93.6%. Antibiotic administration guided by eDENTIFI could have decreased unnecessary IV antibiotic administration in noninfected patients by 10.8% absolute or 46.4% relative percentage points compared with clinicians. CONCLUSION:. eDENTIFI could both decrease the time to antimicrobial administration in infected patients and unnecessary antibiotic administration in noninfected patients. Further prospective validation is needed.
Databáze: Directory of Open Access Journals
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