Development and deployment of interpretable machine-learning model for predicting in-hospital mortality in elderly...

Acute kidney injury (AKI) is more likely to develop in the elderly admitted to the intensive care unit (ICU). Acute kidney disease (AKD) affects ∼45% of patients with AKI and increases short-term mortality. However, there are no studies on the prognosis of AKD in the elderly.

Data from 2666 elderly patients with AKD in the Medical Information Mart for Intensive Care IV were used for model development and 535 in the eICU Collaborative Research Database for external validation. Based on 5 machine learning algorithms, 33 noninvasive parameters were extracted as features for modeling.

In-hospital mortality of AKD in the elderly was 29.6% and 31.8% in development and validation cohorts, respectively. The comprehensive best-performing algorithm was the support vector machine (SVM), and a simplified online application included only 10 features employing SVM (AUC: 0.810 and 0.776 in the training and external validation cohorts, respectively) was deployed. Model interpretation by SHapley Additive exPlanation (SHAP) values revealed that the difference (AKD day - ICU day) in sequential organ failure assessment (delta SOFA), Glasgow coma scale (GCS), delta GCS, delta peripheral oxygen saturation (SpO2), and SOFA were the top five features associated with prognosis. The optimal target was determined by SHAP values from partial dependence plots.

A web-based tool was externally validated and deployed to predict the early prognosis of AKD in the elderly based on readily available noninvasive parameters, assisting clinicians in intervening with precision and purpose to save lives to the greatest extent.