Machine learning in critical care: state-of-the-art and a sepsis case study

Background: Like other scientific fields, such as cosmology, high-energy physics, or even the life sciences, medicine and healthcare face the challenge of an extremely quick transformation into data-driven sciences. This challenge entails the daunting task of extracting usable knowledge from these data using algorithmic methods. In the medical context this may for instance realized through the design of medical decision support systems for diagnosis, prognosis and patient management. The intensive care unit (ICU), and by extension the whole area of critical care, is becoming one of the most data-driven clinical environments. Results: The increasing availability of complex and heterogeneous data at the point of patient attention in critical care environments makes the development of fresh approaches to data analysis almost compulsory. Computational Intelligence (CI) and Machine Learning (ML) methods can provide such approaches and have already shown their usefulness in addressing problems in this context. The current study has a dual goal: it is first a review of the state-of-the-art on the use and application of such methods in the field of critical care. Such review is presented from the viewpoint of the different subfields of critical care, but also from the viewpoint of the different available ML and CI techniques. The second goal is presenting a collection of results that illustrate the breath of possibilities opened by ML and CI methods using a single problem, the investigation of septic shock at the ICU. Conclusion: We have presented a structured state-of-the-art that illustrates the broad-ranging ways in which ML and CI methods can make a difference in problems affecting the manifold areas of critical care. The potential of ML and CI has been illustrated in detail through an example concerning the sepsis pathology. The new definitions of sepsis and the relevance of using the systemic inflammatory response syndrome (SIRS) in its diagnosis have been considered. Conditional independence models have been used to address this problem, showing that SIRS depends on both organ dysfunction measured through the Sequential Organ Failure (SOFA) score and the ICU outcome, thus concluding that SIRS should still be considered in the study of the pathophysiology of Sepsis. Current assessment of the risk of dead at the ICU lacks specificity. ML and CI techniques are shown to improve the assessment using both indicators already in place and other clinical variables that are routinely measured. Kernel methods in particular are shown to provide the best performance balance while being amenable to representation through graphical models, which increases their interpretability and, with it, their likelihood to be accepted in medical practice.Peer ReviewedPostprint (published version

CareFall: Automatic Fall Detection through Wearable Devices and AI Methods

The aging population has led to a growing number of falls in our society, affecting global public health worldwide. This paper presents CareFall, an automatic Fall Detection System (FDS) based on wearable devices and Artificial Intelligence (AI) methods. CareFall considers the accelerometer and gyroscope time signals extracted from a smartwatch. Two different approaches are used for feature extraction and classification: i) threshold-based, and ii) machine learning-based. Experimental results on two public databases show that the machine learning-based approach, which combines accelerometer and gyroscope information, outperforms the threshold-based approach in terms of accuracy, sensitivity, and specificity. This research contributes to the design of smart and user-friendly solutions to mitigate the negative consequences of falls among older people.Comment: 3 pages, 1 figure, 2 table

ChildCI Framework: Analysis of Motor and Cognitive Development in Children-Computer Interaction for Age Detection

This article presents a comprehensive analysis of the different tests proposed in the recent ChildCI framework, proving its potential for generating a better understanding of children's neuromotor and cognitive development along time, as well as their possible application in other research areas such as e-Health and e-Learning. In particular, we propose a set of over 100 global features related to motor and cognitive aspects of the children interaction with mobile devices, some of them collected and adapted from the literature. Furthermore, we analyse the robustness and discriminative power of the proposed feature set including experimental results for the task of children age group detection based on their motor and cognitive behaviors. Two different scenarios are considered in this study: i) single-test scenario, and ii) multiple-test scenario. Results over 93% accuracy are achieved using the publicly available ChildCIdb_v1 database (over 400 children from 18 months to 8 years old), proving the high correlation of children's age with the way they interact with mobile devices.Comment: 11 pages, 2 figures, 6 table

Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting

Epidemiologia; Mortalitat; Shock sèpticEpidemiología; Mortalidad; Shock sépticoEpidemiology; Mortality; Septic shockBackground Up-to-date identification of local trends in sepsis incidence and outcomes is of considerable public health importance. The aim of our study was to estimate annual incidence rates and in-hospital mortality trends for hospitalized patients with sepsis in a European setting, while avoiding selection bias in relation to different complexity hospitals. Methods A large retrospective analysis of a 5-year period (2008–2012) was conducted of hospital discharge records obtained from the Catalan Health System (CatSalut) Minimum Basic Data Set for Acute-Care Hospitals (a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia). Patients hospitalized with sepsis were detected on the basis of ICD-9-CM codes used to identify acute organ dysfunction and infectious processes. Results Of 4,761,726 discharges from all acute-care hospitals in Catalonia, 82,300 cases (1.72%) had sepsis diagnoses. Annual incidence was 212.7 per 100,000 inhabitants/year, rising from 167.2 in 2008 to 261.8 in 2012. Length of hospital stay fell from 18.4 to 15.3 days (p < .00001), representing a relative reduction of 17%. Hospital mortality fell from 23.7 to 19.7% (p < .0001), representing a relative reduction of 16.9%. These differences were confirmed in the multivariate analysis (adjusted for age group, sex, comorbidities, ICU admission, emergency admission, organ dysfunction, number of organ failures, sepsis source and bacteraemia). Conclusions Sepsis incidence has risen in recent years, whereas mortality has fallen. Our findings confirm reports for other parts of the world, in the context of scarce administrative data on sepsis in Europe.The study was partially funded by the Mataró Sepsis Challenge (www.sepsischallenge.cat) through the Fundació Salut del Consorci Sanitari del Maresme

The Use of CytoSorb Therapy in Critically Ill COVID-19 Patients: Review of the Rationale and Current Clinical Experiences

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Teràpia CytoSorbCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Terapia; CytoSorbCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; CytoSorb; TherapyThe COVID-19 pandemic has led to the biggest global health crisis of our lifetime. There is accumulating evidence that a substantial number of critically ill COVID-19 patients exhibit a dysregulated host response manifesting as cytokine storm or cytokine release syndrome, which in turn contributes to the high observed rates of mortality. Just as in other hyperinflammatory conditions, extracorporeal cytokine removal may have potential beneficial effects in this subgroup of COVID-19 patients. The CytoSorb blood purification device is the most extensively investigated cytokine removal platform with considerable evidence suggesting that early intervention can provide rapid hemodynamic stabilization and improvement in vital organ functions. The purpose of this review is to provide an overview of the pathophysiological background of hyperinflammation in COVID-19 and to summarize the currently available evidence on the effects of hemoadsorption in these patients

Trends in mortality in septic patients according to the different organ failure during 15 years

Sepsis syndrome; Epidemiologic methods; Septic shockSíndrome séptico; Métodos epidemiológicos; Choque sépticoSíndrome sèptic; Mètodes epidemiològics; Xoc sèpticBackground The incidence of sepsis can be estimated between 250 and 500 cases/100.000 people per year and is responsible for up to 6% of total hospital admissions. Identified as one of the most relevant global health problems, sepsis is the condition that generates the highest costs in the healthcare system. Important changes in the management of septic patients have been included in recent years; however, there is no information about how changes in the management of sepsis-associated organ failure have contributed to reduce mortality. Methods A retrospective analysis was conducted from hospital discharge records from the Minimum Basic Data Set Acute-Care Hospitals (CMBD-HA in Catalan language) for the Catalan Health System (CatSalut). CMBD-HA is a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia. Sepsis was defined by the presence of infection and at least one organ dysfunction. Patients hospitalized with sepsis were detected, according ICD-9-CM (since 2005 to 2017) and ICD-10-CM (2018 and 2019) codes used to identify acute organ dysfunction and infectious processes. Results Of 11.916.974 discharges from all acute-care hospitals during the study period (2005–2019), 296.554 had sepsis (2.49%). The mean annual sepsis incidence in the population was 264.1 per 100.000 inhabitants/year, and it increased every year, going from 144.5 in 2005 to 410.1 in 2019. Multiorgan failure was present in 21.9% and bacteremia in 26.3% of cases. Renal was the most frequent organ failure (56.8%), followed by cardiovascular (24.2%). Hospital mortality during the study period was 19.5%, but decreases continuously from 25.7% in 2005 to 17.9% in 2019 (p < 0.0001). The most important reduction in mortality was observed in cases with cardiovascular failure (from 47.3% in 2005 to 31.2% in 2019) (p < 0.0001). In the same way, mean mortality related to renal and respiratory failure in sepsis was decreased in last years (p < 0.0001). Conclusions The incidence of sepsis has been increasing in recent years in our country. However, hospital mortality has been significantly reduced. In septic patients, all organ failures except liver have shown a statistically significant reduction on associated mortality, with cardiovascular failure as the most relevant.The study is part of a project that has received a grant from the "Fundació Marató TV3", entitled: "Sepsis Training, Analysis and Feedback (STAF) strategy for the implementation of Sepsis Code" (Id Num: 201836_10)

Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?

Coronavirus; Multisystem inflammatory syndrome in children; Pediatric critical careCoronavirus; Síndrome inflamatorio multisistémico en niños; Cuidados críticos pediátricosCoronavirus; Síndrome inflamatòria multisistèmica en nens; Cures crítiques pediàtriquesMultisystem inflammatory syndrome (MIS-C) is a new severe clinical condition that has emerged during the COVID-19 pandemic. MIS-C affects children and the young usually after a mild or asymptomatic COVID-19 infection. MIS-C has a high tropism for the cardiovascular system with need for inotropes and vasopressor support in 62% of cases. As of today a mortality from 1.5% to 1.9% related to MIS-C is reported. Hemoadsorption via the inflammatory mediator adsorber CytoSorb (CytoSorbents Europe, Berlin Germany) has been used as adjunctive therapy with the aim to restore the host response in septic shock and other hyper-inflammatory syndromes. We present the clinical experience of an adolescent boy with a refractory shock secondary to left ventricular dysfunction (LVD) in the context of MIS-C, treated with hemoadsorption, and continuous kidney replacement therapy (CKRT) in combination with immunomodulatory therapies. The therapeutic strategy resulted in hemodynamic and clinical stabilization as well as control of the hyperinflammatory response. Treatment appeared to be safe and feasible. Our findings are in line with previously published clinical cases on Cytosorb use in MIS-C showing the beneficial role of the hemoperfusion with Cytosorb in severe MIS-C to manage the cytokine storm. We provide an analysis and comparison of recent evidence on the use of hemoadsorption as an adjuvant therapy in critically ill children with severe forms of MIS-C, suggesting this blood purification strategy could be a therapeutic opportunity in severe LVD due to MIS-C, sparing the need for extracorporeal membrane oxygentation (ECMO) and other mechanical cardiocirculatory supports

Pre-analytical and analytical procedures to avoid loss of vitamin C. Comment on: “COVID-19: up to 82% critically ill patients had low vitamin C values”

COVID-19; Vitamin CCOVID-19; Vitamina CCOVID-19; Vitamina

Automatic tuning and matching of a small multifrequency saddle coil at 4.7 T

A new circuit design for automatically tuning and matching a saddle coil for small animal imaging is presented. This design allows working at 1H, 19F, and 3He resonance frequencies in a 4.7 T spectrometer. It is based on a balanced circuit with commercial variable capacity diodes controlled by a computer using digital potentiometers. The change between two different frequencies can be accurately performed in a few seconds. System Q is compared, between 140–210 MHz, to the same coil tuned and matched with high Q variable capacitors. Differences lower than 5% were found with a loaded coil. The proposed design has initially been evaluated in 19F and 1H NMR images acquired with a five-tube phantom. An application is also shown for the acquisition of 3He, 19F, and 1H lung images in a control ratPublicad