An XGBoost machine learning model using routine electronic health record data predicted the development of cardiogenic shock 2 hours prior to clinical intervention with an overall area under the curve of 0.87.
Observational (n=115,291)
Yes
Does an XGBoost machine learning model using routinely collected electronic health record data accurately predict the development of cardiogenic shock 2 hours prior to clinical recognition?
A machine learning model using routinely collected electronic health record data can accurately predict the onset of cardiogenic shock 2 hours before standard clinical recognition, potentially allowing for earlier life-saving interventions.
Effect estimate: AUC 0.87
Cardiogenic shock (CS) is a severe condition with in-hospital mortality of up to 50%. Patients who develop CS may have previous cardiac history, but that may not always be the case, adding to the challenges in optimally identifying and managing these patients. Patients may present to a medical facility with CS or develop CS while in the emergency department (ED), in a general inpatient ward (WARD) or in the critical care unit (CC). While different clinical pathways for management exist once CS is recognized, there are challenges in identifying the patients in a timely manner, in all settings, in a timeframe that will allow proper management. We therefore developed and evaluated retrospectively a machine learning model based on the XGBoost (XGB) algorithm which runs automatically on patient data from the electronic health record (EHR). The algorithm was trained on 8 years of de-identified data (from 2010 to 2017) collected from a large regional healthcare system. The input variables include demographics, vital signs, laboratory values, some orders, and specific pre-existing diagnoses. The model was designed to make predictions 2 h prior to the need of first CS intervention (inotrope, vasopressor, or mechanical circulatory support). The algorithm achieves an overall area under curve (AUC) of 0.87 (0.81 in CC, 0.84 in ED, 0.97 in WARD), which is considered useful for clinical use. The algorithm can be refined based on specific elements defining patient subpopulations, for example presence of acute myocardial infarction (AMI) or congestive heart failure (CHF), further increasing its precision when a patient has these conditions. The top-contributing risk factors learned by the model are consistent with existing clinical findings. Our conclusion is that a useful machine learning model can be used to predict the development of CS. This manuscript describes the main steps of the development process and our results.
Chang et al. (Wed,) conducted a observational in Cardiogenic shock (n=115,291). XGBoost machine learning model was evaluated on Prediction of cardiogenic shock 2 hours prior to first intervention (measured by Area Under the Curve) (AUC 0.87). An XGBoost machine learning model using routine electronic health record data predicted the development of cardiogenic shock 2 hours prior to clinical intervention with an overall area under the curve of 0.87.