Abstract
Mortality prediction for intensive care unit (ICU) patients is a challenging problem that requires extracting discriminative and informative features. This study presents a proof of concept for exploring features that can provide clinical insight. Through a feature engineering approach, it is attempted to improve ICU mortality prediction in field conditions with low frequently measured data (i.e., hourly to bi-hourly). Features are explored by investigating the vital signs measurements of ICU patients, labelled with mortality or survival at discharge. The vital signs of interest in this study are heart and respiration rate, oxygen saturation and blood pressure. The latter comprises systolic, diastolic and mean arterial pressure. In the feature exploration process, it is aimed to extract simple and interpretable features that can provide clinical insight. For this purpose, a classifier is required that maximises the margin between the two classes (i.e., survival and mortality) with minimum tolerance to misclassification errors. Moreover, it preferably has to provide a linear decision surface in the original feature space without mapping to an unlimited dimensionality feature space. Therefore, a linear hard margin support vector machine (SVM) classifier is suggested. The extracted features are grouped in three categories: statistical, dynamic and physiological. Each category plays an important role in enhancing classification error performance. After extracting several features within the three categories, a manual feature fine-tuning is applied to consider only the most efficient features. The final classification, considering mortality as the positive class, resulted in an accuracy of 91.56 % , sensitivity of 90.59 % , precision of 86.52 % and F 1 -score of 88.50 % . The obtained results show that the proposed feature engineering approach and the extracted features are valid to be considered and further enhanced for the mortality prediction purpose. Moreover, the proposed feature engineering approach moved the modelling methodology from black-box modelling to grey-box modelling in combination with the powerful classifier of SVMs.
Highlights
Intensive care unit (ICU) patients are admitted because of an acute critical illness or because of the high need for intensive continuous monitoring
The correctly classified patients are fixed over the different test trials because of using the linear hard margin support vector machine (SVM)
Despite the remarkable reduction in the number of true positives (TP)’s, 18 new TP’s are recognised by the dynamic features that are not recognised by the statistical features, in addition to 116 new true negatives (TN)’s
Summary
Intensive care unit (ICU) patients are admitted because of an acute critical illness or because of the high need for intensive continuous monitoring. Sci. 2019, 9, 3525 rapid deterioration, resulting in a possibly fatal outcome when not monitored closely. The main challenge at the ICU is to reduce the morbidity of the admitted patients and prevent mortality which has a high likelihood due to severe illness [1]. Mortality prevention requires an intensive monitoring of vital signs, such as heart and respiration rate, oxygen saturation, non-invasive or arterial blood pressure, and so forth, that can capture clinical deterioration earlier and improve patient outcome
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