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Prediction of Neurological Outcomes in Out-of-hospital Cardiac Arrest Survivors Immediately after Return of Spontaneous Circulation: Ensemble Technique with Four Machine Learning Models.
- Source :
-
Journal of Korean medical science [J Korean Med Sci] 2021 Jul 19; Vol. 36 (28), pp. e187. Date of Electronic Publication: 2021 Jul 19. - Publication Year :
- 2021
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Abstract
- Background: We performed this study to establish a prediction model for 1-year neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) immediately after ROSC using machine learning methods.<br />Methods: We performed a retrospective analysis of an OHCA survivor registry. Patients aged ≥ 18 years were included. Study participants who had registered between March 31, 2013 and December 31, 2018 were divided into a develop dataset (80% of total) and an internal validation dataset (20% of total), and those who had registered between January 1, 2019 and December 31, 2019 were assigned to an external validation dataset. Four machine learning methods, including random forest, support vector machine, ElasticNet and extreme gradient boost, were implemented to establish prediction models with the develop dataset, and the ensemble technique was used to build the final prediction model. The prediction performance of the model in the internal validation and the external validation dataset was described with accuracy, area under the receiver-operating characteristic curve, area under the precision-recall curve, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Futhermore, we established multivariable logistic regression models with the develop set and compared prediction performance with the ensemble models. The primary outcome was an unfavorable 1-year neurological outcome.<br />Results: A total of 1,207 patients were included in the study. Among them, 631, 139, and 153 were assigned to the develop, the internal validation and the external validation datasets, respectively. Prediction performance metrics for the ensemble prediction model in the internal validation dataset were as follows: accuracy, 0.9620 (95% confidence interval [CI], 0.9352-0.9889); area under receiver-operator characteristics curve, 0.9800 (95% CI, 0.9612-0.9988); area under precision-recall curve, 0.9950 (95% CI, 0.9860-1.0000); sensitivity, 0.9594 (95% CI, 0.9245-0.9943); specificity, 0.9714 (95% CI, 0.9162-1.0000); PPV, 0.9916 (95% CI, 0.9752-1.0000); NPV, 0.8718 (95% CI, 0.7669-0.9767). Prediction performance metrics for the model in the external validation dataset were as follows: accuracy, 0.8509 (95% CI, 0.7825-0.9192); area under receiver-operator characteristics curve, 0.9301 (95% CI, 0.8845-0.9756); area under precision-recall curve, 0.9476 (95% CI, 0.9087-0.9867); sensitivity, 0.9595 (95% CI, 0.9145-1.0000); specificity, 0.6500 (95% CI, 0.5022-0.7978); PPV, 0.8353 (95% CI, 0.7564-0.9142); NPV, 0.8966 (95% CI, 0.7857-1.0000). All the prediction metrics were higher in the ensemble models, except NPVs in both the internal and the external validation datasets.<br />Conclusion: We established an ensemble prediction model for prediction of unfavorable 1-year neurological outcomes in OHCA survivors using four machine learning methods. The prediction performance of the ensemble model was higher than the multivariable logistic regression model, while its performance was slightly decreased in the external validation dataset.<br />Competing Interests: The authors have no potential conflicts of interest to disclose.<br /> (© 2021 The Korean Academy of Medical Sciences.)
- Subjects :
- Aged
Cardiopulmonary Resuscitation adverse effects
Cardiopulmonary Resuscitation methods
Emergency Medical Services
Female
Heart Arrest diagnosis
Heart Arrest therapy
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest mortality
Registries
Retrospective Studies
Survival Rate
Treatment Outcome
Heart Arrest mortality
Machine Learning
Out-of-Hospital Cardiac Arrest therapy
Return of Spontaneous Circulation
Survivors statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1598-6357
- Volume :
- 36
- Issue :
- 28
- Database :
- MEDLINE
- Journal :
- Journal of Korean medical science
- Publication Type :
- Academic Journal
- Accession number :
- 34282605
- Full Text :
- https://doi.org/10.3346/jkms.2021.36.e187