Abstract P391: An-adcs 2 : A Novel Machine-Learning Model to Predict the Risk of Stroke-Associated Pneumonia

Abstract

Objective: We aimed to develop and validate a machine learning-based prediction model that could assess the risk of stroke-associated pneumonia (SAP) for individual patients with acute ischemic stroke (AIS). Methods: A machine-learning model incorporating A 2 DS 2 scores and clinical features (AN-ADCS 2 ) was developed to predict the risk of SAP in patients with AIS. Two independent datasets were used for model derivation and external validation. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated. The further analysis evaluated thresholds from the training set that identified patients as low-risk, intermediate-risk and high-risk, and performance at these thresholds was compared in the external validation set. Results: The AN-ADCS 2 model achieved favorable performance with a high AUC of 0.892 (95% confidence interval [CI] 0.885-0.898) in the test set and similar performance in the external validation set (AUC 0.813 [95% CI 0.812-0.814]). The AN-ADCS 2 threshold identifying low-risk was 0.03, with a NPV of 97.6% (97.2-97.9%) and sensitivity of 93.5% (92.5-94.5%). The AN-ADCS 2 threshold identifying high-risk was 0.65, with a PPV of 94.7% (93.9-95.6%) and specificity of 99.5% (99.5-99.6%). The AN-ADCS 2 model performed better than the A 2 DS 2 score (AUC 0.739, 95%CI [0.720-0.754]). Having a high risk of SAP classified by the AN-ADCS 2 was associated with unfavorable outcomes of mortality and in-hospital stroke recurrence. Conclusions: Using machine learning, the AN-ADCS 2 model provides an individualized risk prediction of SAP, which can be used as an indicator of clinical prognosis for patients with AIS.