Supervised classification techniques and deep

learning for mortality prediction in sepsis

patients

A. Rodriguez (1); D. Mendoza (2); J. Ascuntar (2); F. Jaimes (2)

● (1) System engineering, Universidad Nacional, Medellín, Colombia
● (2) Internal medicine, Universidad de Antioquia, Medellin, Colombia

Introduction:
Sepsis mortality is still unacceptably high and an appropriate prognostic tool may
increase the accuracy for clinical decisions. Several techniques of artificial
intelligence (AI) are currently providing efficient ways for data mining and analysis.

Objective:
To develop and to evaluate several supervised techniques of data mining and AI for
classification and prediction of mortality in adult patients hospitalized by emergency
services with sepsis diagnosis.
 Supervised classification techniques and deep learning
for mortality prediction in sepsis patients

Methods:
Secondary data analysis of a prospective cohort conducted between June
2014 and February 2016 in three emergency services in Medellin, Colombia.

The outcome variable was hospital mortality and the prediction variables were
grouped in either those related with treatment and initial clinical attention or
those that measure directly physiological derangements.

Five supervised classification techniques were analyzed: C4.5 Decision Tree

(C4.5), Random Forest (RF), Artificial Neural Network (ANN) and Support
Vector Machine (SVM) by either dot or ANOVA.
 Supervised classification techniques and deep learning
for mortality prediction in sepsis patients
Results: prediction variables related with treatment and initial clinical attention.
Variable Total Alive Death P
(2510) (2221; 88.5%) (289; 11.5%)
Central venous catheter 187 (7.5%) 117 (5.3%) 70 (24.2%) < 0.001
Intravenous fluids in the first 6 1955 (77.9%) 1716 (77.3%) 239 (82.7%) 0.036
hours
Arterial line placement (n=2509) 123 (4.9%) 73 (3.3%) 50 (17.4%) < 0.001
Central venous oxygen 1 (0.04%) 1 (0.05%) 0 0.718
saturation
Red blood cell transfusion 53 (2.1%) 39 (1.8%) 14 (4.8%) 0.001
Dobutamine in the first 24 hours 14 (0.6%) 8 (0.4%) 6 (2.1%) < 0.001
Antibiotics within first 3 hours 790 (31.4%) 683 (30.8%) 107 (37%) 0.031
Blood culture 2185 (87.1%) 1918 (86.4%) 267 (92.4%) 0.004
Cardiovascular score
MAP ≥70 1170 (46.6%) 1074 (48.4%) 96 (33.2%) < 0.001
MAP <70 941 (37.5%) 866 (39%) 75 (26%)
Vasopressor 399 (15.9%) 281 (12.6%) 118 (40.8%)
 Supervised classification techniques and deep learning
for mortality prediction in sepsis patients
Results: prediction variables that measure directly physiological derangements.
Variable Total Alive Death P
(2510) (2221; 88.5%) (289; 11.5%)
Systolic blood pressure 109 (88 – 130) 110 (88 – 130) 102 (84 – 125) 0.014
Respiratory rate (n=2503) 20 (18 – 22) 19 (18 – 22) 22 (18 – 28) < 0.001
Temperature (n=2481) 37 (36.7 – 38.4) 37.1 (36.8 – 38.5) 37 (36.6 – 37.7) < 0.001
Glasgow coma scale 15 (15 – 15) 15 (15 – 15) 15 (14 – 15) < 0.001
(n=2480)
Charlson Comorbidity 1 (0 – 2) 1 (0 – 2) 1 (0 – 2) 0.015
Index
PaO2/FiO2 Index 287.6 (213.9 – 357.1) 291.2 (223.8 – 361.9) 228 (130.6 – 323.8) < 0.001
(n=2153)
Platelets (n=2488) 232000 (163000 – 236000 (168000 – 198000 (122000 – < 0.001
319000) 322000) 290000)
Creatinine (n=2455) 1.2 (0.8 – 2.2) 1.2 (0.8 – 2.1) 1.5 (0.9 – 2.9) < 0.001
arterial pH (n=2161) 7.4 (7.4- 7.5) 7.4 (3.4 – 7.5) 7.4 (7.3 – 7.5) < 0.001
Hematocrit (n=2507) 37.1 (32.1 – 42.1) 37.3 (32.3 – 42.1) 35.9 (30 – 42.1) 0.008
Lactate level at admission 2.5 (1.5 – 3.5) 2.4 (1.5 – 3.4) 3.1 (2 – 4.6) < 0.001
(n=2381)
 Supervised classification techniques and deep learning
for mortality prediction in sepsis patients
Results:
The study cohort was composed of 2510 patients with a median age of 62 years
(IQR=46-74) and an overall hospital mortality rate of 11.5% (n=289).
Model Physiological Treatment

Accuracy AUC-ROC Accuracy AUC-ROC

C4.5 56,7 0,64 54,9 0,55

RF 60,6 0,66 59,3 0,55
ANN 64,7 0,88 60 0,58
SVM dot 68,9 0,71 60,3 0,61
SVM Anova 70,5 0,80 61 0,61

*C4.5 Decision Tree (C4.5), Random Forest (RF), Artificial Neural Network (ANN) and Support Vector
Machine (SVM) by either dot or ANOVA
 Supervised classification techniques and deep learning
for mortality prediction in sepsis patients
Conclusions:

Deep learning and artificial intelligence are increasingly used as

supporting tools in clinical medicine. Their performance in such a
complex and heterogeneous syndrome as sepsis may be a new a horizon
in clinical research. Artificial Neural Networks seem promising for
improving sepsis classification and prognosis.
Acknowledgment: