TY  - JOUR
AU  - Li, Jili
AU  - Liu, Siru
AU  - Hu, Yundi
AU  - Zhu, Lingfeng
AU  - Mao, Yujia
AU  - Liu, Jialin
PY  - 2022
DA  - 2022/8/9
TI  - Predicting Mortality in Intensive Care Unit Patients With Heart Failure Using an Interpretable Machine Learning Model: Retrospective Cohort Study
JO  - J Med Internet Res
SP  - e38082
VL  - 24
IS  - 8
KW  - heart failure
KW  - mortality
KW  - intensive care unit
KW  - prediction
KW  - XGBoost
KW  - SHAP
KW  - SHapley Additive exPlanation
AB  - Background: Heart failure (HF) is a common disease and a major public health problem. HF mortality prediction is critical for developing individualized prevention and treatment plans. However, due to their lack of interpretability, most HF mortality prediction models have not yet reached clinical practice. Objective: We aimed to develop an interpretable model to predict the mortality risk for patients with HF in intensive care units (ICUs) and used the SHapley Additive exPlanation (SHAP) method to explain the extreme gradient boosting (XGBoost) model and explore prognostic factors for HF. Methods: In this retrospective cohort study, we achieved model development and performance comparison on the eICU Collaborative Research Database (eICU-CRD). We extracted data during the first 24 hours of each ICU admission, and the data set was randomly divided, with 70% used for model training and 30% used for model validation. The prediction performance of the XGBoost model was compared with three other machine learning models by the area under the curve. We used the SHAP method to explain the XGBoost model. Results: A total of 2798 eligible patients with HF were included in the final cohort for this study. The observed in-hospital mortality of patients with HF was 9.97%. Comparatively, the XGBoost model had the highest predictive performance among four models with an area under the curve (AUC) of 0.824 (95% CI 0.7766-0.8708), whereas support vector machine had the poorest generalization ability (AUC=0.701, 95% CI 0.6433-0.7582). The decision curve showed that the net benefit of the XGBoost model surpassed those of other machine learning models at 10%~28% threshold probabilities. The SHAP method reveals the top 20 predictors of HF according to the importance ranking, and the average of the blood urea nitrogen was recognized as the most important predictor variable. Conclusions: The interpretable predictive model helps physicians more accurately predict the mortality risk in ICU patients with HF, and therefore, provides better treatment plans and optimal resource allocation for their patients. In addition, the interpretable framework can increase the transparency of the model and facilitate understanding the reliability of the predictive model for the physicians. 
SN  - 1438-8871
UR  - https://www.jmir.org/2022/8/e38082
UR  - https://doi.org/10.2196/38082
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35943767
DO  - 10.2196/38082
ID  - info:doi/10.2196/38082
ER  -