Rating organ failure via adverse events using data mining in the intensive care unit.
OBJECTIVE
The main intensive care unit (ICU) goal is to avoid or reverse the organ failure process by adopting a timely intervention. Within this context, early identification of organ impairment is a key issue. The sequential organ failure assessment (SOFA) is an expert-driven score that is widely used in European ICUs to quantify organ disorder. This work proposes a complementary data-driven approach based on adverse events, defined from commonly monitored biometrics. The aim is to study the impact of these events when predicting the risk of ICU organ failure.


METHODS
A large database was considered, with a total of 25,215 daily records taken from 4425 patients and 42 European ICUs. The input variables include the case mix (i.e. age, diagnosis, admission type and admission from) and adverse events defined from four bedside physiologic variables (i.e. systolic blood pressure, heart rate, pulse oximeter oxygen saturation and urine output). The output target is the organ status (i.e. normal, dysfunction or failure) of six organ systems (respiratory, coagulation, hepatic, cardiovascular, neurological and renal), as measured by the SOFA score. Two data mining (DM) methods were compared: multinomial logistic regression (MLR) and artificial neural networks (ANNs). These methods were tested in the R statistical environment, using 20 runs of a 5-fold cross-validation scheme. The area under the receiver operator characteristic (ROC) curve and Brier score were used as the discrimination and calibration measures.


RESULTS
The best performance was obtained by the ANNs, outperforming the MLR in both discrimination and calibration criteria. The ANNs obtained an average (over all organs) area under the ROC curve of 64, 69 and 74% and Brier scores of 0.18, 0.16 and 0.09 for the dysfunction, normal and failure organ conditions, respectively. In particular, very good results were achieved when predicting renal failure (ROC curve area of 76% and Brier score of 0.06).


CONCLUSIONS
Adverse events, taken from bedside monitored data, are important intermediate outcomes, contributing to a timely recognition of organ dysfunction and failure during ICU length of stay. The obtained results show that it is possible to use DM methods to get knowledge from easy obtainable data, thus making room for the development of intelligent clinical alarm monitoring.
Silva
Alvaro
A
Serviço de Cuidados Intensivos, Hospital Geral de Santo António, Porto, Portugal.
Cortez
Paulo
P
Santos
Manuel Filipe
MF
Gomes
Lopes
L
Neves
José
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D019540:Area Under Curve; D002138:Calibration; D016208:Databases, Factual; D005060:Europe; D005103:Expert Systems; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000503:physiopathology*; D016571:Neural Networks, Computer; D010092:Oximetry; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012984:Software; D014563:Urodynamics / Q000502:physiology; D055815:Young Adult