7 Artificial Intelligence and Machine Learning as a Predictive Tool for Acute Kidney Injury in Trauma and Severely Burned Patients

Abstract

Abstract Introduction Kidney injury doubles burn mortality—thus, early prediction of acute kidney injury (AKI) in the burn population could benefit from artificial intelligence (AI) and machine learning (ML). Our objective in this study was to build and assess the theoretical performances of such AI/ML algorithms and to develop generalizable models that could augment AKI recognition. Methods Two databases containing patients that received neutrophil gelatinase associated lipocalin (NGAL), creatinine, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and urine output (UOP) measurements at admission were used to train, test, and generalize the AI/ML models. Models were first optimized in Cohort A for predicting AKI in Cohort B. Cohort A (n = 50) was based on a retrospective dataset of adult (age³18 years) burn patients, while Cohort B (n = 51) consisted of prospectively enrolled adult burned or non-burned trauma patients at risk for AKI. We employed a grid search and cross validation approach in building 68,100 unique ML models from five distinct ML approaches: logistic regression (LR), k-nearest neighbor (k-NN), support vector machine (SVM), random forest (RF), and deep neural networks (DNN) which enabled us to find the most accurate ML models. Results The best generalization accuracy (86%), sensitivity (91%), and specificity (85%) with NGAL alone was noted with LR, SVM and RF models. Generalizability prediction accuracy, sensitivity and specificity were respectively highest with the optimized DNN model (92%, 100%, and 90%) and the k-NN model (92%, 91%, and 93%) when tested with Cohort B using all four biomarkers. k-NN provided best generalization accuracy (84%) without NGAL using only NT-proBNP and creatinine, followed by DNN using creatinine only with an accuracy of 82%. AI/ML algorithms using results obtained at admission accelerated the average (SD) time to AKI prediction by 61.8 (32.5) hours. Conclusions NGAL is analytically superior to traditional AKI biomarkers such as creatinine and UOP. With machine learning, the AKI predictive capability of NGAL can be further enhanced and accelerated when combined with NT-proBNP, UOP, and creatinine. Applicability of Research to Practice Without NGAL, machine learning models continue to provide robust means in accelerating the prediction of AKI using both common and biomarkers of cardiorenal dysfunction.