Related Experiment Videos
Admission-Based Machine-Learning Models for Predicting Mechanical Ventilation and Mortality in Fibrotic Interstitial
Jibo Sun1,2, Xirui Chen3, Xiangpeng Wang4
1Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Background:
Admission-based risk stratification tools are limited for hospitalized patients with fibrotic interstitial lung disease (F-ILD).
Aims:
To develop and externally validate admission-based machine-learning models for predicting mechanical ventilation (MV), 30-day and 3-month mortality, and long-term all-cause and cause-specific mortality in hospitalized patients with F-ILD.
Study Design:
Multicenter retrospective cohort study.
Methods:
This study included hospitalized adults with F-ILD from two tertiary hospitals in China. Clinical characteristics and laboratory test results obtained within 24 hours of admission were used as candidate predictors. Machine-learning models were developed to predict MV, 30-day and 3-month mortality, and long-term all-cause and cause-specific mortality, with internal testing and independent external validation. Model performance, clinical utility, and interpretability were evaluated.
Results:
A total of 1,272 patients were included (derivation cohort, n = 1,006; external validation cohort, n = 266). In the external validation cohort, the models demonstrated robust discrimination for MV [area under the curve (AUC), 0.913], 30-day mortality (AUC, 0.926), and 3-month mortality (AUC, 0.813). For long-term all-cause mortality, the final model achieved a C-index of 0.768, with time-dependent AUCs of 0.811 at 12 months and 0.768 at 24 months. The corresponding values for cause-specific mortality were 0.768, 0.815, and 0.761, respectively. Lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI) emerged as key predictors of MV and short-term mortality, whereas long-term mortality risk was additionally associated with older age, male sex, smoking history, an idiopathic pulmonary fibrosis phenotype, and lower albumin-to-globulin ratio and platelet-to-white blood cell ratio.
Conclusion:
Admission-based models demonstrated strong discriminatory performance for predicting MV and mortality in hospitalized patients with F-ILD. Elevated LDH and NLR levels, together with lower PNI, characterized a high-risk profile for acute deterioration and death. Local recalibration may be necessary before implementation in new clinical settings.
