Affiliation:
1. Division of Health Services Research, Department of Foundations of Medicine New York University Long Island School of Medicine Mineola NY
2. Department of Otolaryngology‐Head and Neck Surgery, Bill Wilkerson Center Vanderbilt University Medical Center Nashville TN
3. Department of Public Health Sciences Clemson University Clemson SC
4. Department of Medicine and Vascular Biology Center Medical College of Georgia Augusta GA
Abstract
Background
Peripheral artery disease (PAD) affects >10 million people in the United States. PAD is associated with poor outcomes, including premature death. Machine learning (ML) has been increasingly used on big data to predict clinical outcomes. This study aims to develop ML models to predict in‐hospital mortality in patients hospitalized for PAD based on a national database.
Methods and Results
Inpatient hospitalization data were obtained from the 2016 to 2019 National Inpatient Sample. A total of 150 921 inpatients were identified with a primary diagnosis of PAD and PAD‐related procedures using codes of the
International Classification of Diseases, Tenth Revision, Clinical Modification
(
ICD‐10‐CM
) and
International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD‐10‐PCS)
. Four ML models, including logistic regression, random forest, light gradient boosting, and extreme gradient boosting models, were trained to predict the risk of in‐hospital death based on a selection of variables, including patient characteristics, comorbidities, procedures, and hospital‐related factors. In‐hospital mortality occurred in 1.8% of patients. The performance of the 4 models was comparable, with the area under the receiver operating characteristic curve ranging from 0.83 to 0.85, sensitivity of 77% to 82%, and specificity of 72% to 75%. These results suggest adequate predictability for clinical decision‐making. In all 4 models, the total number of diagnoses and procedures, age, endovascular revascularization procedure, congestive heart failure, diabetes, and diabetes with complications were critical predictors of in‐hospital mortality.
Conclusions
This study demonstrates the feasibility of ML in predicting in‐hospital mortality in patients with a primary PAD diagnosis. Findings highlight the potential of ML models in identifying high‐risk patients for poor outcomes and guiding personalized intervention.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine