Using artificial intelligence to predict adverse outcomes in emergency department patients with hyperglycemic crises in real time

BMC Endocrine Disorders

Research Article

Jhi-Joung Wang¹  Chin-Chuan Hsu²  Yuan Kao³  Chien-Chin Hsu⁴  Chien-Cheng Huang⁵  Hung-Jung Lin⁶  Chung-Feng Liu⁷  Shu-Lien Hsu⁸  Tzu-Lan Liu⁹  Chia-Jung Chen⁹ 

[1] Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan;Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan;Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, 710, Tainan City, Taiwan;Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, 710, Tainan City, Taiwan;Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan;Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, 710, Tainan City, Taiwan;School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan;Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, 710, Tainan City, Taiwan;School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan;Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan;Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, 710, Tainan City, Taiwan;School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan;Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan;Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, 710, Tainan City, Taiwan;Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan;Information Systems, Chi Mei Medical Center, Tainan, Taiwan;

关键词: Adverse outcome;    Artificial intelligence;    Emergency department;    Hyperglycemic crises;    Intensive care unit;    Machine learning;    Mortality;    Multilayer perceptron;    Sepsis;   

DOI  :  10.1186/s12902-023-01437-9

 received in 2020-09-12, accepted in 2023-08-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHyperglycemic crises are associated with high morbidity and mortality. Previous studies have proposed methods to predict adverse outcomes of patients in hyperglycemic crises; however, artificial intelligence (AI) has never been used to predict adverse outcomes. We implemented an AI model integrated with the hospital information system (HIS) to clarify whether AI could predict adverse outcomes.MethodsWe included 2,666 patients with hyperglycemic crises from emergency departments (ED) between 2009 and 2018. The patients were randomized into a 70%/30% split for AI model training and testing. Twenty-two feature variables from the electronic medical records were collected. The performance of the multilayer perceptron (MLP), logistic regression, random forest, Light Gradient Boosting Machine (LightGBM), support vector machine (SVM), and K-nearest neighbor (KNN) algorithms was compared. We selected the best algorithm to construct an AI model to predict sepsis or septic shock, intensive care unit (ICU) admission, and all-cause mortality within 1 month. The outcomes between the non-AI and AI groups were compared after implementing the HIS and predicting the hyperglycemic crisis death (PHD) score.ResultsThe MLP had the best performance in predicting the three adverse outcomes, compared with the random forest, logistic regression, SVM, KNN, and LightGBM models. The areas under the curves (AUCs) using the MLP model were 0.852 for sepsis or septic shock, 0.743 for ICU admission, and 0.796 for all-cause mortality. Furthermore, we integrated the AI predictive model with the HIS to assist decision making in real time. No significant differences in ICU admission or all-cause mortality were detected between the non-AI and AI groups. The AI model performed better than the PHD score for predicting all-cause mortality (AUC 0.796 vs. 0.693).ConclusionsA real-time AI predictive model is a promising method for predicting adverse outcomes in ED patients with hyperglycemic crises. Further studies recruiting more patients are warranted.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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