Development and Validation of a Convolutional Neural Network Model for ICU Acute Kidney Injury Prediction

Abstract

ABSTRACTRationale and objectivesAcute kidney injury (AKI) is common among hospitalized patients and has a significant impact on morbidity and mortality. While early prediction of AKI has the potential to reduce adverse patient outcomes, it remains a difficult condition to predict and diagnose. The purpose of this study was to evaluate the ability of a machine learning algorithm to predict for AKI KDIGO Stage 2 or 3 up to 72 hours in advance of onset using convolutional recurrent neural nets (CNN) and patient Electronic Health Record (EHR) data.MethodsA CNN prediction system was developed to continuously and automatically monitor for incipient AKI. 7122 patient encounters were retrospectively analyzed from the Medical Information Mart for Intensive Care III (MIMIC-III) database.New Predictors and Established PredictorsNew predictor - CNN machine learning-based AKI prediction model. Established predictors - XGBoost AKI prediction model and the Sequential Organ Failure Assessment (SOFA) scoring system.OutcomesAKI onset.Analytical ApproachThe model was trained on routinely-collected patient EHR data. Measurements included Area Under the Receiver Operating Characteristic (AUROC) curve, positive predictive value (PPV), and a battery of additional performance metrics for 72 hour advance prediction of AKI onset.ResultsOn a hold-out test set, the algorithm attained an AUROC of 0.85 and PPV of 0.25, relative to a cohort AKI prevalence of 5.21%, for long-horizon AKI prediction at a 72-hour window prior to onset.ConclusionsA CNN machine learning-based AKI prediction model outperforms XGBoost and the SOFA scoring system, demonstrating superior performance in predicting acute kidney injury 72 hours prior to onset, without reliance on changes in serum creatinine.