Prediction of acute kidney injury in patients with liver cirrhosis using machine learning models: evidence from the MIMIC-III and MIMIC-IV.

Abstract

To develop and validate a machine learning (ML)-based prediction model for acute kidney injury (AKI) in patients with liver cirrhosis. Data on liver cirrhosis patients were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) and MIMIC-IV databases in this retrospective cohort study. ML algorithms, including random forest (RF), extreme gradient boosting (XGB), light gradient boosting machine (LGBM), and gradient boosting decision tree (GBDT) were applied to construct prediction models. Predictors were screened via univariate logistic regression, and then the models were developed with all data of the included patients. A bootstrap resampling method was adopted to validate the models. The predictive abilities of our final model were compared with those of the sequential organ failure assessment score (SOFA), simplified acute physiology score II (SAPS II), Model for End-stage Liver Disease (MELD), and MELD Na. This study included 950 patients, of which 429 (45.16%) had AKI. Mechanical ventilation, vasopressor, international normalized ratio (INR), bilirubin, Charlson comorbidity index (CCI), prothrombin time (PT), estimated glomerular filtration rate (EGFR), partial thromboplastin time (PTT), and heart rate served as predictors. In the derivation set, the developed RF [area under curve (AUC) = 0.747], XGB (AUC = 0.832), LGBM (AUC = 0.785), and GBDT (AUC = 0.811) models exhibited significantly greater predictive performance than the logistic regression model (AUC = 0.699) (all P < 0.05). Among the ML-based models, the XGB model had the greatest AUC. In internal validation, the predictive capacity of the XGB model (AUC = 0.833) was significantly superior to that of the logistic regression model (AUC = 0.701) (P = 0.045). Hence, the XGB model was selected as the final model for AKI prediction. In contrast to the XGB model (AUC = 0.832), the SOFA (AUC = 0.609), MELD (AUC = 0.690), MELD Na (AUC = 0.690), and SAPS II (AUC = 0.641) had significantly lower predictive abilities in the derivation set (all P < 0.001). The XGB model was internally validated to have an AUC of 0.833, which was significantly higher than the SOFA (AUC = 0.609), MELD (AUC = 0.690), MELD Na (AUC = 0.688), and SAPS II (AUC = 0.641) (all P < 0.05). The XGB model had a better performance than the logistic regression model, SOFA, MELD, MELD Na, and SAPS II in AKI prediction for cirrhosis patients, which may help identify patients at a risk of AKI, and then provide timely interventions.