Deep Learning Models to Predict Fatal Pneumonia Using Chest X-Ray Images.

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Chest X-ray (CXR) is indispensable to the assessment of severity, diagnosis, and management of pneumonia. Deep learning is an artificial intelligence (AI) technology that has been applied to the interpretation of medical images. This study investigated the feasibility of classifying fatal pneumonia based on CXR images using deep learning models on publicly available platforms. CXR images of patients with pneumonia at diagnosis were labeled as fatal or nonfatal based on medical records. We applied CXR images from 1031 patients with nonfatal pneumonia and 243 patients with fatal pneumonia for training and self-evaluation of the deep learning models. All labeled CXR images were randomly allocated to the training, validation, and test datasets of deep learning models. Data augmentation techniques were not used in this study. We created two deep learning models using two publicly available platforms. The first model showed an area under the precision-recall curve of 0.929 with a sensitivity of 50.0% and a specificity of 92.4% for classifying fatal pneumonia. We evaluated the performance of our deep learning models using sensitivity, specificity, PPV, negative predictive value (NPV), accuracy, and F1 score. Using the external validation test dataset of 100 CXR images, the sensitivity, specificity, accuracy, and F1 score were 68.0%, 86.0%, 77.0%, and 74.7%, respectively. In the original dataset, the performance of the second model showed a sensitivity, specificity, and accuracy of 39.6%, 92.8%, and 82.7%, respectively, while external validation showed values of 38.0%, 92.0%, and 65.0%, respectively. The F1 score was 52.1%. These results were comparable to those obtained by respiratory physicians and residents. The deep learning models yielded good accuracy in classifying fatal pneumonia. By further improving the performance, AI could assist physicians in the severity assessment of patients with pneumonia.