A machine-learning approach for dynamic prediction of sepsis-induced coagulopathy in critically ill patients with sepsis: an integrated analysis of the MIMIC-IV and eICU-CRD databases

Abstract Background Sepsis-induced coagulopathy (SIC) denotes an increased mortality rate and poorer prognosis in septic patients. Methods Machine-learning models were developed based on septic patients who were older than 18 years and stayed in intensive care units (ICUs) for more than 24 hours in Medical Information Mart for Intensive Care (MIMIC)-IV. Eighty-eight potential predictors were extracted, and 15 various machine-learning models assessed the daily risk of SIC. The most potent model was selected based on its accuracy and Area Under the receiver operating characteristic Curve (AUC), followed by fine-grained hyperparameter adjustment using the Bayesian Optimization Algorithm. The effects of features on prediction scores were measured using the SHapley Additive exPlanations (SHAP) values. A compact model was developed, based on 15 features selected according to their importance and clinical availability. Two models were compared with Logistic Regression and SIC scores in terms of SIC prediction. Additionally, an external validation was performed in the eICU Collaborative Research Database (eICU-CRD). Results Of 11362 patients in MIMIC-IV included in the final cohort, a total of 6744 (59%) patients had SIC during sepsis, and 16183 samples were extracted. The model named Categorical Boosting (CatBoost) had the greatest AUC in our study (0.869 [0.850, 0.886]). Coagulation profile and renal function indicators are the most important features to predict SIC. A compact model was developed with the AUC of 0.854 [0.832, 0.872], while the AUCs of Logistic Regression and SIC scores were 0.746 [0.735, 0.755] and 0.709 [0.687, 0.733], respectively. A cohort of 35252 septic patients in eICU-CRD was analyzed. The AUCs of the full and the compact models in external validation were 0.842 [0.837, 0.846] and 0.803 [0.798, 0.809], respectively, which were still larger than those of Logistic Regression (0.660 [0.653, 0.667]) and SIC scores (0.752 [0.747, 0.757]). Prediction results can be illustrated by using SHAP values in the instance level, which makes our models clinically interpretable. Conclusions We developed two models which were able to dynamically predict the risk of SIC in septic patients better than conventional Logistic Regression and SIC scores. Prediction results of our two models can be interpreted by using SHAP values.