scholarly journals Does Artificial Intelligence Make Clinical Decision Better? A Review of Artificial Intelligence and Machine Learning in Acute Kidney Injury Prediction

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1662
Author(s):  
Tao Han Lee ◽  
Jia-Jin Chen ◽  
Chi-Tung Cheng ◽  
Chih-Hsiang Chang
Keyword(s):  
Artificial Intelligence ◽  
Machine Learning ◽  
Acute Kidney Injury ◽  
Prediction Models ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Current Evidence ◽  
Learning Models ◽  
Definition Of ◽  
Machine Learning Models

Acute kidney injury (AKI) is a common complication of hospitalization that greatly and negatively affects the short-term and long-term outcomes of patients. Current guidelines use serum creatinine level and urine output rate for defining AKI and as the staging criteria of AKI. However, because they are not sensitive or specific markers of AKI, clinicians find it difficult to predict the occurrence of AKI and prescribe timely treatment. Advances in computing technology have led to the recent use of machine learning and artificial intelligence in AKI prediction, recent research reported that by using electronic health records (EHR) the AKI prediction via machine-learning models can reach AUROC over 0.80, in some studies even reach 0.93. Our review begins with the background and history of the definition of AKI, and the evolution of AKI risk factors and prediction models is also appraised. Then, we summarize the current evidence regarding the application of e-alert systems and machine-learning models in AKI prediction.

scholarly journals Machine Learning Approach to Reduce Alert Fatigue Using a Disease Medication–Related Clinical Decision Support System: Model Development and Validation (Preprint)

2020 ◽  
Author(s):  
Tahmina Nasrin Poly ◽  
Md.Mohaimenul Islam ◽  
Muhammad Solihuddin Muhtar ◽  
Hsuan-Chia Yang ◽  
Phung Anh (Alex) Nguyen ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Prediction Models ◽  
Clinical Decision ◽  
Gradient Boosting ◽  
Support Vector ◽  
Learning Models ◽  
Alert Fatigue ◽  
Machine Learning Models

BACKGROUND Computerized physician order entry (CPOE) systems are incorporated into clinical decision support systems (CDSSs) to reduce medication errors and improve patient safety. Automatic alerts generated from CDSSs can directly assist physicians in making useful clinical decisions and can help shape prescribing behavior. Multiple studies reported that approximately 90%-96% of alerts are overridden by physicians, which raises questions about the effectiveness of CDSSs. There is intense interest in developing sophisticated methods to combat alert fatigue, but there is no consensus on the optimal approaches so far. OBJECTIVE Our objective was to develop machine learning prediction models to predict physicians’ responses in order to reduce alert fatigue from disease medication–related CDSSs. METHODS We collected data from a disease medication–related CDSS from a university teaching hospital in Taiwan. We considered prescriptions that triggered alerts in the CDSS between August 2018 and May 2019. Machine learning models, such as artificial neural network (ANN), random forest (RF), naïve Bayes (NB), gradient boosting (GB), and support vector machine (SVM), were used to develop prediction models. The data were randomly split into training (80%) and testing (20%) datasets. RESULTS A total of 6453 prescriptions were used in our model. The ANN machine learning prediction model demonstrated excellent discrimination (area under the receiver operating characteristic curve [AUROC] 0.94; accuracy 0.85), whereas the RF, NB, GB, and SVM models had AUROCs of 0.93, 0.91, 0.91, and 0.80, respectively. The sensitivity and specificity of the ANN model were 0.87 and 0.83, respectively. CONCLUSIONS In this study, ANN showed substantially better performance in predicting individual physician responses to an alert from a disease medication–related CDSS, as compared to the other models. To our knowledge, this is the first study to use machine learning models to predict physician responses to alerts; furthermore, it can help to develop sophisticated CDSSs in real-world clinical settings.

scholarly journals Machine Learning Models of Acute Kidney Injury Prediction in Acute Pancreatitis Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Cheng Qu ◽  
Lin Gao ◽  
Xian-qiang Yu ◽  
Mei Wei ◽  
Guo-quan Fang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
Acute Pancreatitis ◽  
Logistic Regression ◽  
Kidney Injury ◽  
Gradient Boosting ◽  
Support Vector ◽  
Learning Models ◽  
Extreme Gradient Boosting ◽  
Machine Learning Models

Background. Acute kidney injury (AKI) has long been recognized as a common and important complication of acute pancreatitis (AP). In the study, machine learning (ML) techniques were used to establish predictive models for AKI in AP patients during hospitalization. This is a retrospective review of prospectively collected data of AP patients admitted within one week after the onset of abdominal pain to our department from January 2014 to January 2019. Eighty patients developed AKI after admission (AKI group) and 254 patients did not (non-AKI group) in the hospital. With the provision of additional information such as demographic characteristics or laboratory data, support vector machine (SVM), random forest (RF), classification and regression tree (CART), and extreme gradient boosting (XGBoost) were used to build models of AKI prediction and compared to the predictive performance of the classic model using logistic regression (LR). XGBoost performed best in predicting AKI with an AUC of 91.93% among the machine learning models. The AUC of logistic regression analysis was 87.28%. Present findings suggest that compared to the classical logistic regression model, machine learning models using features that can be easily obtained at admission had a better performance in predicting AKI in the AP patients.

scholarly journals Machine Learning Approach to Reduce Alert Fatigue Using a Disease Medication–Related Clinical Decision Support System: Model Development and Validation

10.2196/19489 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e19489
Author(s):  
Tahmina Nasrin Poly ◽  
Md.Mohaimenul Islam ◽  
Muhammad Solihuddin Muhtar ◽  
Hsuan-Chia Yang ◽  
Phung Anh (Alex) Nguyen ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Prediction Models ◽  
Clinical Decision ◽  
Gradient Boosting ◽  
Support Vector ◽  
Learning Models ◽  
Alert Fatigue ◽  
Machine Learning Models

Background Computerized physician order entry (CPOE) systems are incorporated into clinical decision support systems (CDSSs) to reduce medication errors and improve patient safety. Automatic alerts generated from CDSSs can directly assist physicians in making useful clinical decisions and can help shape prescribing behavior. Multiple studies reported that approximately 90%-96% of alerts are overridden by physicians, which raises questions about the effectiveness of CDSSs. There is intense interest in developing sophisticated methods to combat alert fatigue, but there is no consensus on the optimal approaches so far. Objective Our objective was to develop machine learning prediction models to predict physicians’ responses in order to reduce alert fatigue from disease medication–related CDSSs. Methods We collected data from a disease medication–related CDSS from a university teaching hospital in Taiwan. We considered prescriptions that triggered alerts in the CDSS between August 2018 and May 2019. Machine learning models, such as artificial neural network (ANN), random forest (RF), naïve Bayes (NB), gradient boosting (GB), and support vector machine (SVM), were used to develop prediction models. The data were randomly split into training (80%) and testing (20%) datasets. Results A total of 6453 prescriptions were used in our model. The ANN machine learning prediction model demonstrated excellent discrimination (area under the receiver operating characteristic curve [AUROC] 0.94; accuracy 0.85), whereas the RF, NB, GB, and SVM models had AUROCs of 0.93, 0.91, 0.91, and 0.80, respectively. The sensitivity and specificity of the ANN model were 0.87 and 0.83, respectively. Conclusions In this study, ANN showed substantially better performance in predicting individual physician responses to an alert from a disease medication–related CDSS, as compared to the other models. To our knowledge, this is the first study to use machine learning models to predict physician responses to alerts; furthermore, it can help to develop sophisticated CDSSs in real-world clinical settings.

Biostatistiek versus machine learning: van traditionele predictiemodellen naar geautomatiseerde medische analyse

2021 ◽  
Author(s):  
M. VALKEMA ◽  
H. LINGSMA ◽  
P. LAMBIN ◽  
J. VAN LANSCHOT
Keyword(s):  
Machine Learning ◽  
Prediction Models ◽  
External Validation ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Learning Models ◽  
Selection Of Variables ◽  
Medical Analysis ◽  
Machine Learning Models ◽  
Selection Of

Biostatistics versus machine learning: from traditional prediction models to automated medical analysis Machine learning is increasingly applied to medical data to develop clinical prediction models. This paper discusses the application of machine learning in comparison with traditional biostatistical methods. Biostatistics is well-suited for structured datasets. The selection of variables for a biostatistical prediction model is primarily knowledge-driven. A similar approach is possible with machine learning. But in addition, machine learning allows for analysis of unstructured datasets, which are e.g. derived from medical imaging and written texts in patient records. In contrast to biostatistics, the selection of variables with machine learning is mainly data-driven. Complex machine learning models are able to detect nonlinear patterns and interactions in data. However, this requires large datasets to prevent overfitting. For both machine learning and biostatistics, external validation of a developed model in a comparable setting is required to evaluate a model’s reproducibility. Machine learning models are not easily implemented in clinical practice, since they are recognized as black boxes (i.e. non-intuitive). For this purpose, research initiatives are ongoing within the field of explainable artificial intelligence. Finally, the application of machine learning for automated imaging analysis and development of clinical decision support systems is discussed.

scholarly journals Application of Machine Learning to Predict Acute Kidney Disease in Patients With Sepsis Associated Acute Kidney Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiawei He ◽  
Jin Lin ◽  
Meili Duan
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Kidney Injury ◽  
Learning Models ◽  
Short Term ◽  
Acute Kidney Disease ◽  
Mimic Iii ◽  
Machine Learning Models

Background: Sepsis-associated acute kidney injury (AKI) is frequent in patients admitted to intensive care units (ICU) and may contribute to adverse short-term and long-term outcomes. Acute kidney disease (AKD) reflects the adverse events developing after AKI. We aimed to develop and validate machine learning models to predict the occurrence of AKD in patients with sepsis-associated AKI.Methods: Using clinical data from patients with sepsis in the ICU at Beijing Friendship Hospital (BFH), we studied whether the following three machine learning models could predict the occurrence of AKD using demographic, laboratory, and other related variables: Recurrent Neural Network-Long Short-Term Memory (RNN-LSTM), decision trees, and logistic regression. In addition, we externally validated the results in the Medical Information Mart for Intensive Care III (MIMIC III) database. The outcome was the diagnosis of AKD when defined as AKI prolonged for 7–90 days according to Acute Disease Quality Initiative-16.Results: In this study, 209 patients from BFH were included, with 55.5% of them diagnosed as having AKD. Furthermore, 509 patients were included from the MIMIC III database, of which 46.4% were diagnosed as having AKD. Applying machine learning could successfully achieve very high accuracy (RNN-LSTM AUROC = 1; decision trees AUROC = 0.954; logistic regression AUROC = 0.728), with RNN-LSTM showing the best results. Further analyses revealed that the change of non-renal Sequential Organ Failure Assessment (SOFA) score between the 1st day and 3rd day (Δnon-renal SOFA) is instrumental in predicting the occurrence of AKD.Conclusion: Our results showed that machine learning, particularly RNN-LSTM, can accurately predict AKD occurrence. In addition, Δ SOFAnon−renal plays an important role in predicting the occurrence of AKD.

scholarly journals Calibration drift in regression and machine learning models for acute kidney injury

2017 ◽  
Vol 24 (6) ◽  
pp. 1052-1061 ◽  
Author(s):  
Sharon E Davis ◽  
Thomas A Lasko ◽  
Guanhua Chen ◽  
Edward D Siew ◽  
Michael E Matheny
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Acute Kidney Injury ◽  
Regression Models ◽  
Kidney Injury ◽  
Learning Models ◽  
Personalized Risk ◽  
Support Decision Making ◽  
Over Time ◽  
Machine Learning Models

Abstract Objective Predictive analytics create opportunities to incorporate personalized risk estimates into clinical decision support. Models must be well calibrated to support decision-making, yet calibration deteriorates over time. This study explored the influence of modeling methods on performance drift and connected observed drift with data shifts in the patient population. Materials and Methods Using 2003 admissions to Department of Veterans Affairs hospitals nationwide, we developed 7 parallel models for hospital-acquired acute kidney injury using common regression and machine learning methods, validating each over 9 subsequent years. Results Discrimination was maintained for all models. Calibration declined as all models increasingly overpredicted risk. However, the random forest and neural network models maintained calibration across ranges of probability, capturing more admissions than did the regression models. The magnitude of overprediction increased over time for the regression models while remaining stable and small for the machine learning models. Changes in the rate of acute kidney injury were strongly linked to increasing overprediction, while changes in predictor-outcome associations corresponded with diverging patterns of calibration drift across methods. Conclusions Efficient and effective updating protocols will be essential for maintaining accuracy of, user confidence in, and safety of personalized risk predictions to support decision-making. Model updating protocols should be tailored to account for variations in calibration drift across methods and respond to periods of rapid performance drift rather than be limited to regularly scheduled annual or biannual intervals.

scholarly journals Predicting mortality of patients with acute kidney injury in the ICU using XGBoost model

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246306
Author(s):  
Jialin Liu ◽  
Jinfa Wu ◽  
Siru Liu ◽  
Mengdie Li ◽  
Kunchang Hu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
The Other ◽  
Receiver Operating Curve ◽  
Support Vector ◽  
Research Database ◽  
Learning Models ◽  
Risk Of Death ◽  
Machine Learning Models

Purpose The goal of this study is to construct a mortality prediction model using the XGBoot (eXtreme Gradient Boosting) decision tree model for AKI (acute kidney injury) patients in the ICU (intensive care unit), and to compare its performance with that of three other machine learning models. Methods We used the eICU Collaborative Research Database (eICU-CRD) for model development and performance comparison. The prediction performance of the XGBoot model was compared with the other three machine learning models. These models included LR (logistic regression), SVM (support vector machines), and RF (random forest). In the model comparison, the AUROC (area under receiver operating curve), accuracy, precision, recall, and F1 score were used to evaluate the predictive performance of each model. Results A total of 7548 AKI patients were analyzed in this study. The overall in-hospital mortality of AKI patients was 16.35%. The best performing algorithm in this study was XGBoost with the highest AUROC (0.796, p < 0.01), F1(0.922, p < 0.01) and accuracy (0.860). The precision (0.860) and recall (0.994) of the XGBoost model rank second among the four models. Conclusion XGBoot model had obvious advantages of performance compared to the other machine learning models. This will be helpful for risk identification and early intervention for AKI patients at risk of death.

scholarly journals Explainable AI: A Review of Machine Learning Interpretability Methods

Entropy ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 18
Author(s):  
Pantelis Linardatos ◽  
Vasilis Papastefanopoulos ◽  
Sotiris Kotsiantis
Keyword(s):  
Artificial Intelligence ◽  
Machine Learning ◽  
Black Box ◽  
Learning Systems ◽  
Model Complexity ◽  
Learning Models ◽  
New Methods ◽  
Industrial Adoption ◽  
Machine Learning Models ◽  
The Way

Recent advances in artificial intelligence (AI) have led to its widespread industrial adoption, with machine learning systems demonstrating superhuman performance in a significant number of tasks. However, this surge in performance, has often been achieved through increased model complexity, turning such systems into “black box” approaches and causing uncertainty regarding the way they operate and, ultimately, the way that they come to decisions. This ambiguity has made it problematic for machine learning systems to be adopted in sensitive yet critical domains, where their value could be immense, such as healthcare. As a result, scientific interest in the field of Explainable Artificial Intelligence (XAI), a field that is concerned with the development of new methods that explain and interpret machine learning models, has been tremendously reignited over recent years. This study focuses on machine learning interpretability methods; more specifically, a literature review and taxonomy of these methods are presented, as well as links to their programming implementations, in the hope that this survey would serve as a reference point for both theorists and practitioners.

Machine Learning-based Prediction Models for Diagnosis and Prognosis in Inflammatory Bowel Diseases: A Systematic Review

2021 ◽  
Author(s):  
Nghia H Nguyen ◽  
Dominic Picetti ◽  
Parambir S Dulai ◽  
Vipul Jairath ◽  
William J Sandborn ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Risk Prediction ◽  
Statistical Models ◽  
Prediction Models ◽  
Risk Of Bias ◽  
Learning Models ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Machine Learning Models

Abstract Background and Aims There is increasing interest in machine learning-based prediction models in inflammatory bowel diseases (IBD). We synthesized and critically appraised studies comparing machine learning vs. traditional statistical models, using routinely available clinical data for risk prediction in IBD. Methods Through a systematic review till January 1, 2021, we identified cohort studies that derived and/or validated machine learning models, based on routinely collected clinical data in patients with IBD, to predict the risk of harboring or developing adverse clinical outcomes, and reported its predictive performance against a traditional statistical model for the same outcome. We appraised the risk of bias in these studies using the Prediction model Risk of Bias ASsessment (PROBAST) tool. Results We included 13 studies on machine learning-based prediction models in IBD encompassing themes of predicting treatment response to biologics and thiopurines, predicting longitudinal disease activity and complications and outcomes in patients with acute severe ulcerative colitis. The most common machine learnings models used were tree-based algorithms, which are classification approaches achieved through supervised learning. Machine learning models outperformed traditional statistical models in risk prediction. However, most models were at high risk of bias, and only one was externally validated. Conclusions Machine learning-based prediction models based on routinely collected data generally perform better than traditional statistical models in risk prediction in IBD, though frequently have high risk of bias. Future studies examining these approaches are warranted, with special focus on external validation and clinical applicability.

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