Constructing a screening model to identify patients at high risk of hospital-acquired influenza on admission to hospital.

OBJECTIVE

To develop a machine learning (ML)-based admission screening model for hospital-acquired (HA) influenza using routinely available data to support early clinical intervention.

METHODS

The study focused on hospitalized patients from January 2021 to May 2024. The case group consisted of patients with HA influenza, while the control group comprised non-HA influenza patients admitted to the same ward in the HA influenza unit within 2 weeks. The 953 subjects were divided into the training set and the validation set in a 7:3 ratio. Feature screening was performed using least absolute shrinkage and selection operator (LASSO) and the Boruta algorithm. Subsequently eight ML algorithms were applied to analyze and identify the optimal model using a 5-fold cross-validation methodology. And the area under the curve (AUC), area under the precision-recall curve (AP), F1 score, calibration curve and decision curve analysis (DCA) were applied to comprehensively assess the predictive effectiveness of the selected models. Feature factors were selected and feature importance's were assessed using SHapley's additive interpretation (SHAP). Furthermore, an interactive web-based platform was additionally developed to visualize and demonstrate the predictive model.

RESULTS

Age, pneumonia on admission, Chronic renal failure, Malignant tumor, hypoproteinemia, glucocorticoid use, admission to ICU, lymphopenia, BMI were identified as key variables. For the eight ML algorithms, ROC values ranging from 0.548 to 0.812 were observed in the validation set. A comprehensive analysis showed that the XGBoost model predicted the highest accuracy (AUC: 0.812) with an F1 score of 0.590 and the highest A value (0.655). Evaluating the optimal model, the AUC values were 0.995, 0.826, and 0.781 for the training, validation and test sets. The XGBoost model showed strong robust. SHapley's additive interpretation (SHAP) was utilized to analyze the contribution of explanatory variables to the model and their correlation with HA influenza. In addition, we developed a practical online prediction tool to calculate the risk of HA influenza occurrence.

CONCLUSION

Based on the routine data, the XGBoost model demonstrated excellent calibration among all ML algorithms and accurately predicted the risk of HA influenza, thereby serving as an effective tool for early screening of HA influenza.