Using Machine Learning to Predict Hyperchloremia in Critically Ill Patients

Elevated serum chloride levels (hyperchloremia) and the administration of intravenous (IV) fluids with high chloride content have both been associated with increased morbidity and mortality in certain subgroups of critically ill patients, such as those with sepsis. Here, we demonstrate this association in a general intensive care unit (ICU) population using data from the Medical Information Mart for Intensive Care III (MIMIC-III) database and propose the use of supervised learning to predict hyperchloremia in critically ill patients. Clinical variables from records of the first 24h of adult ICU stays were represented as features for four predictive supervised learning classifiers. The best performing model was able to predict second-day hyperchloremia with an AUC of 0.80 and a ratio of 5 false alerts for every true alert, which is a clinically-actionable rate. Our results suggest that clinicians can be effectively alerted to patients at risk of developing hyperchloremia, providing an opportunity to mitigate this risk and potentially improve outcomes.