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September 4, 2026Frontiers in Cardiovascular MedicineOpen Access

Development and external validation of an explainable machine learning model for in-hospital mortality risk stratification in intensive care unit patients with heart failure

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Why the study?

Early risk stratification for in-hospital mortality remains challenging in ICU patients with HF due to clinical heterogeneity and complex pathophysiological interactions, which explainable machine learning may help address.

Does an explainable XGBoost-based machine learning model accurately predict in-hospital all-cause mortality in ICU patients with heart failure?

Population

18,526 development and 314 external validation ICU patients with HF

Comparison

Five machine learning algorithms compared for predicting in-hospital mortality

Design

Retrospective dual-cohort study

Key result

An explainable XGBoost machine learning model using nine routinely available clinical variables predicted in-hospital all-cause mortality with an AUC of 0.877 in an external validation cohort of ICU patients with heart failure.

Authors

LXLiusheng XuWCWei CaoZHZefan Huang

Discussion

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Member takes

Overview

May support ML risk triage in ICU heart failure; leaves open need for prospective outcome trials.

Study Design

Type

Cohort (n=18,840)

Multicenter

Yes

Structured PICO

Does an explainable XGBoost-based machine learning model accurately predict in-hospital all-cause mortality in ICU patients with heart failure?

P
Population
18,840 adult intensive care unit patients with heart failure from two independent cohorts (MIMIC-IV and a Chinese hospital) evaluated for in-hospital mortality risk.
E
Exposure
Explainable Extreme Gradient Boosting (XGBoost) machine learning model using 9 routinely available early clinical variables (including blood urea nitrogen, age, and white blood cell count).
O
Outcome
In-hospital all-cause mortalityhard clinical

Main Result

Effect estimate: AUC 0.877 (95% CI 0.820-0.933)

An explainable XGBoost machine learning model using nine routine clinical variables demonstrated strong discrimination for predicting in-hospital mortality in ICU patients with heart failure, potentially aiding early risk stratification.

Limitations

  • Retrospective study design
  • Limited number of external events (36 deaths) in the validation cohort
  • Significant baseline clinical differences between the development and external validation cohorts
  • Cohort differences between development and validation sets
  • Limited number of external events in the validation cohort

Cite This Study

Xu et al. (2026) conducted a cohort in Heart failure in intensive care unit patients (n=18,840). XGBoost machine learning model vs. Other predictive models (SOFA, APS III, etc.) was evaluated on In-hospital all-cause mortality prediction (AUC in external validation) (AUC 0.877, 95% CI 0.820-0.933). An explainable XGBoost machine learning model using nine routinely available clinical variables predicted in-hospital all-cause mortality with an AUC of 0.877 in an external validation cohort of ICU patients with heart failure.

synapsesocial.com/papers/6aa0beeac83b1b1ead8c936bhttps://doi.org/10.3389/fcvm.2026.1942393
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