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Machine Learning-Based Prediction of Acute Kidney Injury Following Pediatric Cardiac Surgery: Model Development and
Xiao-Qin Luo1, Yi-Xin Kang1, Shao-Bin Duan1
1Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China.
Insights
Machine learning models can now predict cardiac surgery-associated acute kidney injury (CSA-AKI) in children. The XGBoost model accurately identifies high-risk patients using preoperative and intraoperative data for better perioperative care.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Artificial Intelligence in Medicine
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication in pediatric patients, increasing morbidity and mortality.
- Early prediction of CSA-AKI is crucial for timely intervention and improved patient outcomes.
- Identifying high-risk pediatric patients for CSA-AKI remains a clinical challenge.
Purpose of the Study:
- To develop and validate machine learning (ML) models for predicting CSA-AKI in pediatric patients undergoing cardiac surgery.
- To identify key predictive factors for CSA-AKI in this population.
- To provide tools for enhanced perioperative risk stratification and management.
Main Methods:
- A retrospective cohort study involving 3278 pediatric patients (1 month to 18 years) undergoing cardiac surgery with cardiopulmonary bypass.
- Development and validation of ML models, including XGBoost, using preoperative and combined preoperative/intraoperative data.
- Performance evaluation using Area Under the Receiver Operating Characteristic Curve (AUROC) and interpretation via Shapley Additive Explanations (SHAP).
Main Results:
- The XGBoost model demonstrated superior predictive performance, with AUROCs of 0.890 (preoperative) and 0.912 (combined data) in the derivation cohort.
- External validation showed strong performance with AUROCs of 0.857 (preoperative) and 0.889 (combined data).
- Top predictors for CSA-AKI included baseline serum creatinine, perfusion time, body length, operation time, and intraoperative blood loss.
Conclusions:
- Interpretable XGBoost models offer practical tools for the early prediction of CSA-AKI in pediatric cardiac surgery patients.
- These models can aid in risk stratification and inform perioperative management strategies.
- The findings support the integration of ML-based prediction tools into clinical practice for improved pediatric cardiac surgical care.
Background:
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication following pediatric cardiac surgery, which is associated with increased morbidity and mortality. The early prediction of CSA-AKI before and immediately after surgery could significantly improve the implementation of preventive and therapeutic strategies during the perioperative periods. However, there is limited clinical information on how to identify pediatric patients at high risk of CSA-AKI.
Objective:
The study aims to develop and validate machine learning models to predict the development of CSA-AKI in the pediatric population.
Methods:
This retrospective cohort study enrolled patients aged 1 month to 18 years who underwent cardiac surgery with cardiopulmonary bypass at 3 medical centers of Central South University in China. CSA-AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Feature selection was applied separately to 2 data sets: the preoperative data set and the combined preoperative and intraoperative data set. Multiple machine learning algorithms were tested, including K-nearest neighbor, naive Bayes, support vector machines, random forest, extreme gradient boosting (XGBoost), and neural networks. The best performing model was identified in cross-validation by using the area under the receiver operating characteristic curve (AUROC). Model interpretations were generated using the Shapley additive explanations (SHAP) method.
Results:
A total of 3278 patients from one of the centers were used for model derivation, while 585 patients from another 2 centers served as the external validation cohort. CSA-AKI occurred in 564 (17.2%) patients in the derivation cohort and 51 (8.7%) patients in the external validation cohort. Among the considered machine learning models, the XGBoost models achieved the best predictive performance in cross-validation. The AUROC of the XGBoost model using only the preoperative variables was 0.890 (95% CI 0.876-0.906) in the derivation cohort and 0.857 (95% CI 0.800-0.903) in the external validation cohort. When the intraoperative variables were included, the AUROC increased to 0.912 (95% CI 0.899-0.924) and 0.889 (95% CI 0.844-0.920) in the 2 cohorts, respectively. The SHAP method revealed that baseline serum creatinine level, perfusion time, body length, operation time, and intraoperative blood loss were the top 5 predictors of CSA-AKI.
Conclusions:
The interpretable XGBoost models provide practical tools for the early prediction of CSA-AKI, which are valuable for risk stratification and perioperative management of pediatric patients undergoing cardiac surgery.
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