Advanced Predictive Modeling for Enhanced Mortality Prediction in ICU Stroke Patients Using Clinical Data

원문 초록

Background: Stroke is second-leading cause of disability and death among adults. Approximately 17 million people suffer from a stroke annually, with about 85% being ischemic strokes. Predicting mortality of ischemic stroke patients in intensive care unit (ICU) is crucial for optimizing treatment strategies, allocating resources, and improving survival rates. Methods: We acquired data on ICU ischemic stroke patients from MIMIC-IV database, including diagnoses, vital signs, laboratory tests, medications, procedures, treatments, and clinical notes. Stroke patients were randomly divided into training (70%, n=2441), test (15%, n=523), and validation (15%, n=523) sets. To address data imbalances, we applied Synthetic Minority Over-sampling Technique (SMOTE). We selected 30 features for model development, significantly reducing feature number from 1095 used in the best study. We developed a deep learning model to assess mortality risk and implemented several baseline machine learning models for comparison. Results: XGB-DL model, combining XGBoost for feature selection and deep learning, effectively minimized false positives. Model's AUROC improved from 0.865 (95% CI: 0.821 - 0.905) on first day to 0.903 (95% CI: 0.868 - 0.936) by fourth day using data from 3,646 ICU mortality patients in the MIMIC-IV database with 0.945 AUROC (95% CI: 0.944 - 0.947) during training. Although other ML models also performed well in terms of AUROC, we chose Deep Learning for its higher specificity. Conclusions: Through enhanced feature selection and data cleaning, proposed model demonstrates a 13% AUROC improvement compared to existing models while reducing feature number from 1095 in previous studies to 30.