Prediction of Neurological Outcomes in Out-of-hospital Cardiac Arrest Survivors Immediately after Return of Spontaneous Circulation: Ensemble Technique with Four Machine Learning Models

Abstract

Background We performed this study to establish a prediction model for 1-year neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) immediately after ROSC using machine learning methods. Methods We performed a retrospective analysis of an OHCA survivor registry. Patients aged ≥ 18 years were included. Study participants who had registered between March 31, 2013 and December 31, 2018 were divided into a develop dataset (80% of total) and an internal validation dataset (20% of total), and those who had registered between January 1, 2019 and December 31, 2019 were assigned to an external validation dataset. Four machine learning methods, including random forest, support vector machine, ElasticNet and extreme gradient boost, were implemented to establish prediction models with the develop dataset, and the ensemble technique was used to build the final prediction model. The prediction performance of the model in the internal validation and the external validation dataset was described with accuracy, area under the receiver-operating characteristic curve, area under the precision-recall curve, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Futhermore, we established multivariable logistic regression models with the develop set and compared prediction performance with the ensemble models. The primary outcome was an unfavorable 1-year neurological outcome. Results A total of 1,207 patients were included in the study. Among them, 631, 139, and 153 were assigned to the develop, the internal validation and the external validation datasets, respectively. Prediction performance metrics for the ensemble prediction model in the internal validation dataset were as follows: accuracy, 0.9620 (95% confidence interval [CI], 0.9352–0.9889); area under receiver-operator characteristics curve, 0.9800 (95% CI, 0.9612–0.9988); area under precision-recall curve, 0.9950 (95% CI, 0.9860–1.0000); sensitivity, 0.9594 (95% CI, 0.9245–0.9943); specificity, 0.9714 (95% CI, 0.9162–1.0000); PPV, 0.9916 (95% CI, 0.9752–1.0000); NPV, 0.8718 (95% CI, 0.7669–0.9767). Prediction performance metrics for the model in the external validation dataset were as follows: accuracy, 0.8509 (95% CI, 0.7825–0.9192); area under receiver-operator characteristics curve, 0.9301 (95% CI, 0.8845–0.9756); area under precision-recall curve, 0.9476 (95% CI, 0.9087–0.9867); sensitivity, 0.9595 (95% CI, 0.9145–1.0000); specificity, 0.6500 (95% CI, 0.5022–0.7978); PPV, 0.8353 (95% CI, 0.7564–0.9142); NPV, 0.8966 (95% CI, 0.7857–1.0000). All the prediction metrics were higher in the ensemble models, except NPVs in both the internal and the external validation datasets. Conclusion We established an ensemble prediction model for prediction of unfavorable 1-year neurological outcomes in OHCA survivors using four machine learning methods. The prediction perfo...

Prediction model of in-hospital mortality in intensive care unit patients with cardiac arrest: a retrospective analysis of MIMIC -Ⅳ database based on machine learning

“…A lot of variables were reported to correlate with mortality in CA patients, such as hypertension, DM, the use of vasopressor. (32,(48)(49)(50) Nevertheless, our study showed that hypertension, DM and the use of epinephrine and dopamine were not predictors of in-hospital mortality of ICU admitted CA patients, which may be attribute to our relatively small sample size, and the difference in amount and duration of use vasopressors.…”

Prediction model of in-hospital mortality in intensive care unit patients with cardiac arrest: a retrospective analysis of MIMIC -IV database based on machine learning

“…A lot of variables were reported to correlate with mortality in CA patients, such as hypertension, DM, the use of vasopressor [ 13 , 40 , 55 , 56 ]. Nevertheless, our study showed that hypertension, DM and the use of epinephrine and dopamine were not predictors of in-hospital mortality of ICU-admitted CA patients, which may be attributed to our relatively small sample size, and the difference in amount and duration of use vasopressors.…”