Peng Zheng, Varisco Gabriele, Long Xi, Liang Rong-Hao, Kommers Deedee, Cottaar Ward, Andriessen Peter, van Pul Carola
IEEE J Biomed Health Inform. 2023 Jan;27(1):550-561. doi: 10.1109/JBHI.2022.3216055. Epub 2023 Jan 4.
The aim of this study is to develop an explainable late-onset sepsis (LOS) prediction algorithm using continuous multi-channel physiological signals that can be applied to a patient monitor for preterm infants in a neonatal intensive care unit (NICU). The algorithm uses features on heart rate variability (HRV), respiration, and motion, based on electrocardiogram (ECG) and chest impedance (CI). In this study, 127 preterm infants were included, of whom 59 were bloodculture-proven LOS patients and 68 were control patients. Features in 24 hours before the onset of sepsis (LOS group), and an age-matched onset time point (control group) were extracted and fed into machine learning classifiers with gestational age and birth weight. We compared the prediction performance of several well-known classifiers using features from different signal channels (HRV, respiration, and motion) individually as well as their combinations. The prediction performance was evaluated using the area under the receiver-operating-characteristics curve (AUC). The best performance was achieved by an extreme gradient boosting classifier combining features from all signal channels, with an AUC of 0.88, a positive predictive value of 0.80, and a negative predictive value of 0.83 during the 6 hours preceding LOS onset. This feasibility study demonstrates the complementary predictive value of motion information in addition to cardiorespiratory information for LOS prediction. Furthermore, visualization of how each feature in the individual patient impacts the algorithm decision strengthen its interpretability. In clinical practice, it is important to motivate clinical interventions and this visualization method can help to support the clinical decision.
本研究的目的是开发一种可解释的迟发性脓毒症(LOS)预测算法,该算法使用连续多通道生理信号,可应用于新生儿重症监护病房(NICU)中的早产儿患者监测仪。该算法基于心电图(ECG)和胸部阻抗(CI),利用心率变异性(HRV)、呼吸和运动方面的特征。本研究纳入了127名早产儿,其中59名是血培养确诊的LOS患者,68名是对照患者。提取脓毒症发作前24小时(LOS组)以及年龄匹配的发作时间点(对照组)的特征,并将其与胎龄和出生体重一起输入机器学习分类器。我们分别比较了几种知名分类器使用不同信号通道(HRV、呼吸和运动)的特征及其组合后的预测性能。使用受试者工作特征曲线(AUC)下的面积评估预测性能。在LOS发作前6小时,结合所有信号通道特征的极端梯度提升分类器取得了最佳性能,AUC为0.88,阳性预测值为0.80,阴性预测值为0.83。这项可行性研究证明了除心肺信息外,运动信息对LOS预测具有补充预测价值。此外,可视化个体患者中每个特征如何影响算法决策增强了其可解释性。在临床实践中,激发临床干预措施很重要,这种可视化方法有助于支持临床决策。