Evaluation of random forest and ensemble methods at predicting complications following cardiac surgery

Cardiac patients undergoing surgery face increased risk of postoperative complications, due to a combination of factors, including higher risk surgery, their age at time of surgery and the presence of co-morbid conditions. They will therefore require high levels of care and clinical resources throughout their perioperative journey (i.e. before, during and after surgery). Although surgical mortality rates in the UK have remained low, postoperative complications on the other hand are common and can have a significant impact on patients’ quality of life, increase hospital length of stay and healthcare costs. In this study we used and compared several machine learning methods – random forest, AdaBoost, gradient boosting model and stacking – to predict severe postoperative complications after cardiac surgery based on preoperative variables obtained from a surgical database of a large acute care hospital in Scotland. Our results show that AdaBoost has the best overall performance (AUC = 0.731), and also outperforms EuroSCORE and EuroSCORE II in other studies predicting postoperative complications. Random forest (Sensitivity = 0.852, negative predictive value = 0.923), however, and gradient boosting model (Sensitivity = 0.875 and negative predictive value = 0.920) have the best performance at predicting severe postoperative complications based on sensitivity and negative predictive value

Interpretable Machine Learning Model for Clinical Decision Making

Despite machine learning models being increasingly used in medical decision-making and meeting classification predictive accuracy standards, they remain untrusted black-boxes due to decision-makers\u27 lack of insight into their complex logic. Therefore, it is necessary to develop interpretable machine learning models that will engender trust in the knowledge they generate and contribute to clinical decision-makers intention to adopt them in the field. The goal of this dissertation was to systematically investigate the applicability of interpretable model-agnostic methods to explain predictions of black-box machine learning models for medical decision-making. As proof of concept, this study addressed the problem of predicting the risk of emergency readmissions within 30 days of being discharged for heart failure patients. Using a benchmark data set, supervised classification models of differing complexity were trained to perform the prediction task. More specifically, Logistic Regression (LR), Random Forests (RF), Decision Trees (DT), and Gradient Boosting Machines (GBM) models were constructed using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD). The precision, recall, area under the ROC curve for each model were used to measure predictive accuracy. Local Interpretable Model-Agnostic Explanations (LIME) was used to generate explanations from the underlying trained models. LIME explanations were empirically evaluated using explanation stability and local fit (R2). The results demonstrated that local explanations generated by LIME created better estimates for Decision Trees (DT) classifiers

Predicting Cardiac Arrest and Respiratory Failure Using Feasible Artificial Intelligence with Simple Trajectories of Patient Data

We introduce a Feasible Artificial Intelligence with Simple Trajectories for Predicting Adverse Catastrophic Events (FAST-PACE) solution for preparing immediate intervention in emergency situations. FAST-PACE utilizes a concise set of collected features to construct an artificial intelligence model that predicts the onset of cardiac arrest or acute respiratory failure from 1 h to 6 h prior to its occurrence. Data from the trajectory of 29,181 patients in intensive care units of two hospitals includes periodic vital signs, a history of treatment, current health status, and recent surgery. It excludes the results of laboratory data to construct a feasible application in wards, out-hospital emergency care, emergency transport, or other clinical situations where instant medical decisions are required with restricted patient data. These results are superior to previous warning scores including the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS). The primary outcome was the feasibility of an artificial intelligence (AI) model predicting adverse events 1 h to 6 h prior to occurrence without lab data; the area under the receiver operating characteristic curve of this model was 0.886 for cardiac arrest and 0.869 for respiratory failure 6 h before occurrence. The secondary outcome was the superior prediction performance to MEWS (net reclassification improvement of 0.507 for predicting cardiac arrest and 0.341 for predicting respiratory failure) and NEWS (net reclassification improvement of 0.412 for predicting cardiac arrest and 0.215 for predicting respiratory failure) 6 h before occurrence. This study suggests that AI consisting of simple vital signs and a brief interview could predict a cardiac arrest or acute respiratory failure 6 h earlier.ope

Imbalance Learning and Its Application on Medical Datasets

To gain more valuable information from the increasing large amount of data, data mining has been a hot topic that attracts growing attention in this two decades. One of the challenges in data mining is imbalance learning, which refers to leaning from imbalanced datasets. The imbalanced datasets is dominated by some classes (majority) and other under-represented classes (minority). The imbalanced datasets degrade the learning ability of traditional methods, which are designed on the assumption that all classes are balanced and have equal misclassification costs, leading to the poor performance on the minority classes. This phenomenon is usually called the class imbalance problem. However, it is usually the minority classes of more interest and importance, such as sick cases in the medical dataset. Additionally, traditional methods are optimized to achieve maximum accuracy, which is not suitable for evaluating the performance on imbalanced datasets. From the view of data space, class imbalance could be classified as extrinsic imbalance and intrinsic imbalance. Extrinsic imbalance is caused by external factors, such as data transmission or data storage, while intrinsic imbalance means the dataset is inherently imbalanced due to its nature.  As extrinsic imbalance could be fixed by collecting more samples, this thesis mainly focus on on two scenarios of the intrinsic imbalance,  machine learning for imbalanced structured datasets and deep learning for imbalanced image datasets.  Normally, the solutions for the class imbalance problem are named as imbalance learning methods, which could be grouped into data-level methods (re-sampling), algorithm-level (re-weighting) methods and hybrid methods. Data-level methods modify the class distribution of the training dataset to create balanced training sets, and typical examples are over-sampling and under-sampling. Instead of modifying the data distribution, algorithm-level methods adjust the misclassification cost to alleviate the class imbalance problem, and one typical example is cost sensitive methods. Hybrid methods usually combine data-level methods and algorithm-level methods. However, existing imbalance learning methods encounter different kinds of problems. Over-sampling methods increase the minority samples to create balanced training sets, which might lead the trained model overfit to the minority class. Under-sampling methods create balanced training sets by discarding majority samples, which lead to the information loss and poor performance of the trained model. Cost-sensitive methods usually need assistance from domain expert to define the misclassification costs which are task specified. Thus, the generalization ability of cost-sensitive methods is poor. Especially, when it comes to the deep learning methods under class imbalance, re-sampling methods may introduce large computation cost and existing re-weighting methods could lead to poor performance. The object of this dissertation is to understand features difference under class imbalance, to improve the classification performance on structured datasets or image datasets. This thesis proposes two machine learning methods for imbalanced structured datasets and one deep learning method for imbalance image datasets. The proposed methods are evaluated on several medical datasets, which are intrinsically imbalanced.  Firstly, we study the feature difference between the majority class and the minority class of an imbalanced medical dataset, which is collected from a Chinese hospital. After data cleaning and structuring, we get 3292 kidney stone cases treated by Percutaneous Nephrolithonomy from 2012 to 2019. There are 651 (19.78% ) cases who have postoperative complications, which makes the complication prediction an imbalanced classification task. We propose a sampling-based method SMOTE-XGBoost and implement it to build a postoperative complication prediction model. Experimental results show that the proposed method outperforms classic machine learning methods. Furthermore, traditional prediction models of Percutaneous Nephrolithonomy are designed to predict the kidney stone status and overlook complication related features, which could degrade their prediction performance on complication prediction tasks. To this end, we merge more features into the proposed sampling-based method and further improve the classification performance. Overall, SMOTE-XGBoost achieves an AUC of 0.7077 which is 41.54% higher than that of S.T.O.N.E. nephrolithometry, a traditional prediction model of Percutaneous Nephrolithonomy. After reviewing the existing machine learning methods under class imbalance, we propose a novel ensemble learning approach called Multiple bAlance Subset Stacking (MASS). MASS first cuts the majority class into multiple subsets by the size of the minority set, and combines each majority subset with the minority set as one balanced subsets. In this way, MASS could overcome the problem of information loss because it does not discard any majority sample. Each balanced subset is used to train one base classifier. Then, the original dataset is feed to all the trained base classifiers, whose output are used to generate the stacking dataset. One stack model is trained by the staking dataset to get the optimal weights for the base classifiers. As the stacking dataset keeps the same labels as the original dataset, which could avoid the overfitting problem. Finally, we can get an ensembled strong model based on the trained base classifiers and the staking model. Extensive experimental results on three medical datasets show that MASS outperforms baseline methods.  The robustness of MASS is proved over implementing different base classifiers. We design a parallel version MASS to reduce the training time cost. The speedup analysis proves that Parallel MASS could reduce training time cost greatly when applied on large datasets. Specially, Parallel MASS reduces 101.8% training time compared with MASS at most in our experiments.  When it comes to the class imbalance problem of image datasets, existing imbalance learning methods suffer from the problem of large training cost and poor performance.  After introducing the problem of implementing resampling methods on image classification tasks, we demonstrate issues of re-weighting strategy using class frequencies through the experimental result on one medical image dataset.  We propose a novel re-weighting method Hardness Aware Dynamic loss to solve the class imbalance problem of image datasets. After each training epoch of deep neural networks, we compute the classification hardness of each class. We will assign higher class weights to the classes have large classification hardness values and vice versa in the next epoch. In this way, HAD could tune the weight of each sample in the loss function dynamically during the training process. The experimental results prove that HAD significantly outperforms the state-of-the-art methods. Moreover, HAD greatly improves the classification accuracies of minority classes while only making a small compromise of majority class accuracies. Especially, HAD loss improves 10.04% average precision compared with the best baseline, Focal loss, on the HAM10000 dataset. At last, I conclude this dissertation with our contributions to the imbalance learning, and provide an overview of potential directions for future research, which include extensions of the three proposed methods, development of task-specified algorithms, and fixing the challenges of within-class imbalance.2021-06-0

Dynamic Prediction of ICU Mortality Risk Using Domain Adaptation

Early recognition of risky trajectories during an Intensive Care Unit (ICU) stay is one of the key steps towards improving patient survival. Learning trajectories from physiological signals continuously measured during an ICU stay requires learning time-series features that are robust and discriminative across diverse patient populations. Patients within different ICU populations (referred here as domains) vary by age, conditions and interventions. Thus, mortality prediction models using patient data from a particular ICU population may perform suboptimally in other populations because the features used to train such models have different distributions across the groups. In this paper, we explore domain adaptation strategies in order to learn mortality prediction models that extract and transfer complex temporal features from multivariate time-series ICU data. Features are extracted in a way that the state of the patient in a certain time depends on the previous state. This enables dynamic predictions and creates a mortality risk space that describes the risk of a patient at a particular time. Experiments based on cross-ICU populations reveals that our model outperforms all considered baselines. Gains in terms of AUC range from 4% to 8% for early predictions when compared with a recent state-of-the-art representative for ICU mortality prediction. In particular, models for the Cardiac ICU population achieve AUC numbers as high as 0.88, showing excellent clinical utility for early mortality prediction. Finally, we present an explanation of factors contributing to the possible ICU outcomes, so that our models can be used to complement clinical reasoning

Machine learning for real-time prediction of complications induced by flexible uretero-renoscopy with laser lithotripsy

It is not always easy to predict the outcome of a surgery. Peculiarly, when talking about the risks associated to a given intervention or the possible complications that it may bring about. Thus, predicting those potential complications that may arise during or after a surgery will help minimize risks and prevent failures to the greatest extent possible. Therefore, the objectif of this article is to propose an intelligent system based on machine learning, allowing predicting the complications related to a flexible uretero-renoscopy with laser lithotripsy for the treatment of kidney stones. The proposed method achieved accuracy with 100% for training and, 94.33% for testing in hard voting, 100% for testing and 95.38% for training in soft voting, with only ten optimal features. Additionally, we were able to evaluted the machine learning model by examining the most significant features using the shpley additive explanations (SHAP) feature importance plot, dependency plot, summary plot, and partial dependency plots

Machine learning prediction of mortality in acute myocardial infarction

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Acute Myocardial Infarction (AMI) is the leading cause of death in Portugal and globally. The present investigation created a model based on machine learning for predictive analysis of mortality in patients with AMI upon admission, using different variables to analyse their impact on predictive models. Methods: Three experiments were built for mortality in AMI in a Portuguese hospital between 2013 and 2015 using various machine learning techniques. The three experiments differed in the number and type of variables used. We used a discharged patients' episodes database, including administrative data, laboratory data, and cardiac and physiologic test results, whose primary diagnosis was AMI. Results: Results show that for Experiment 1, Stochastic Gradient Descent was more suitable than the other classification models, with a classification accuracy of 80%, a recall of 77%, and a discriminatory capacity with an AUC of 79%. Adding new variables to the models increased AUC in Experiment 2 to 81% for the Support Vector Machine method. In Experiment 3, we obtained an AUC, in Stochastic Gradient Descent, of 88% and a recall of 80%. These results were obtained when applying feature selection and the SMOTE technique to overcome imbalanced data. Conclusions: Our results show that the introduction of new variables, namely laboratory data, impacts the performance of the methods, reinforcing the premise that no single approach is adapted to all situations regarding AMI mortality prediction. Instead, they must be selected, considering the context and the information available. Integrating Artificial Intelligence (AI) and machine learning with clinical decision-making can transform care, making clinical practice more efficient, faster, personalised, and effective. AI emerges as an alternative to traditional models since it has the potential to explore large amounts of information automatically and systematically.The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).info:eu-repo/semantics/publishedVersio