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The Acidemia Index: A Near Real-Time Risk Analytics Algorithm is Associated With Measured Acidemia in Pediatric
Ahmed Asfari1, Avihu Z Gazit2, Craig Futterman3
1Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX.
Insights
A new algorithm accurately predicts acidemia (ACD), a dangerous condition in critically ill children, especially those with heart defects. This tool can help doctors intervene earlier to improve patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Biomedical Data Science
- Predictive Analytics in Healthcare
Background:
- Acidemia is a common and dangerous complication in pediatric critical care, particularly in patients with congenital heart defects.
- Early prediction of worsening acidemia is crucial for timely interventions and improved patient outcomes.
Purpose of the Study:
- To evaluate the association of a novel, near real-time predictive analytics algorithm, the acidemia (ACD) index, with the occurrence of acidemia in pediatric intensive care unit (ICU) patients.
- To assess the potential of the ACD index to identify patients at risk for acidemia.
Main Methods:
- A retrospective observational study was conducted across nine tertiary institutions in the United States.
- Data from 1858 pediatric patients (12 years or younger) admitted to ICUs between February 2018 and November 2020 were analyzed, including 24,431 arterial blood pH measurements.
- An ACD index was validated using the Etiometry platform, calculated via a physiologic algorithm incorporating real-time laboratory and clinical data using Bayes' theorem.
Main Results:
- The ACD index demonstrated strong performance in predicting acidemia, with an area under the receiver operating characteristic curve of 0.93.
- Higher ACD index values were significantly associated with an increased likelihood of acidemia (p < 0.01).
- The relative risk of acidemia was low (0.11) when the ACD index was less than 1, and the relative risk of not having acidemia was high (0.38) when the index was greater than 99.
Conclusions:
- The novel ACD index is associated with the likelihood of acidemia in a large pediatric critical care cohort.
- This predictive tool shows potential for identifying significant clinical status changes in pediatric patients.
- Further prospective studies are warranted to confirm the clinical utility of the ACD index in managing pediatric critical illness.
Objectives:
Acidemia frequently evolves in pediatric critical care patients, especially with congenital heart defects. Worsening acidemia secondary to inadequate systemic oxygen delivery can be detrimental to patients' outcomes and the ability to predict it has the potential to prompt early interventions to improve the clinical state. We aimed to evaluate the association of a novel near real-time predictive analytics algorithm with acidemia (ACD) (arterial pH < 7.25) in pediatric patients admitted to a critical care unit.
Study Design:
Retrospective observational study in nine tertiary institutions in the United States.
Setting:
Majority of patients were admitted to the cardiac ICU. Using Etiometry platform data (Etiometry, Boston, MA), acidemia (ACD) index was validated.
Patients:
Patients 12 years old or younger were admitted to an ICU between February 1, 2018, and November 31, 2020.
Intervention:
A total of 24,431 arterial blood pH measurements from 1858 patients were included in the validation dataset. The ACD index was calculated using a physiologic algorithm that incorporates patients' variables including laboratory and clinical data. Based on the previous assessment of the physiologic state of the patient, the physiologic algorithm interprets the new data in a real-time manner using Bayes' theorem.
Measurement And Main Results:
Based on a complete dataset, the area under the receiver operating characteristic curve of the ACD index was 0.93. As the index value increased, the likelihood of having acidemia increased (p < 0.01). The relative risk of having acidemia when the ACD index is less than 1 was 0.11 (95% CI, 0.07-0.15), and the relative risk of not having acidemia when the ACD index was greater than 99 was 0.38 (95% CI, 0.32-0.46).
Conclusions:
In this large pediatric cohort, higher ACD index values were associated with a higher likelihood of having acidemia. Consequently, this novel index has the potential to identify severe changes in clinical status. Prospective analysis of the ACD index is important to understand its utility in the management of pediatric critical illness.
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