Analysis of the Impact of Medical Features and Risk Prediction of Acute Kidney Injury for Critical Patients Using Temporal Electronic Health Record Data With Attention-Based Neural Network

Frontiers in Medicine

Yinqiong Huang¹  Xuri Sun¹  Yuming Fang¹  Xieli Guo²  Yuren Zhang²  Jinting Xu²  Ming Chen²  Qiuna Li²  Zhimeng Chen³  Yu Liu⁴  Lianwei Wu⁵  Xiahong Lin⁶ 

[1] Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China;Department of Nephrology, Jinjiang Municipal Hospital, Quanzhou, China;Information Department, Fujian Province Lianpu Network Technology Co., Ltd., Quanzhou, China;Network and Information Technology Center, Sun Yat-sen University, Guangzhou, China;School of Informatics, Xiamen University, Xiamen, China;The Department of Endocrinology of the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China;

关键词: acute kidney injury;    medical features impact;    electronic health record data;    temporal convolutional network;    attention based neural network;   

DOI  :  10.3389/fmed.2021.658665

来源: Frontiers

【 摘 要 】

Acute kidney injury (AKI) is one of the most severe consequences of kidney injury, and it will also cause or aggravate the complications by the fast decline of kidney excretory function. Accurate AKI prediction, including the AKI case, AKI stage, and AKI onset time interval, can provide adequate support for effective interventions. Besides, discovering how the medical features affect the AKI result may also provide supporting information for disease treatment. An attention-based temporal neural network approach was employed in this study for AKI prediction and for the analysis of the impact of medical features from temporal electronic health record (EHR) data of patients before AKI diagnosis. We used the publicly available dataset provided by the Medical Information Mart for Intensive Care (MIMIC) for model training, validation, and testing, and then the model was applied in clinical practice. The improvement of AKI case prediction is around 5% AUC (area under the receiver operating characteristic curve), and the AUC value of AKI stage prediction on AKI stage 3 is over 82%. We also analyzed the data by two steps: the associations between the medical features and the AKI case (positive or inverse) and the extent of the impact of medical features on AKI prediction result. It shows that features, such as lactate, glucose, creatinine, blood urea nitrogen (BUN), prothrombin time (PT), and partial thromboplastin time (PTT), are positively associated with the AKI case, while there are inverse associations between the AKI case and features such as platelet, hemoglobin, hematocrit, urine, and international normalized ratio (INR). The laboratory test features such as urine, glucose, creatinine, sodium, and blood urea nitrogen and the medication features such as nonsteroidal anti-inflammatory drugs, agents acting on the renin–angiotensin system, and lipid-lowering medication were detected to have higher weights than other features in the proposed model, which may imply that these features have a great impact on the AKI case.

【 授权许可】

CC BY