Purpose: This study aimed to construct a mortality model for the risk stratification of intensive care unit (ICU) patients with sepsis by applying a machine learning algorithm. Methods: Adult patients who were diagnosed with sepsis during admission to ICU were extracted from MIMIC-III, MIMIC-IV, eICU, and Zigong databases. MIMIC-III was used for model development and internal validation. The other three databases were used for external validation. Our proposed model was developed based on the Extreme Gradient Boosting (XGBoost) algorithm. The generalizability, discrimination, and validation of our model were evaluated. The Shapley Additive Explanation values were used to interpret our model and analyze the contribution of individual features. Results: A total of 16,741, 15,532, 22,617, and 1,198 sepsis patients were extracted from the MIMIC-III, MIMIC-IV, eICU, and Zigong databases, respectively. The proposed model had an area under the receiver operating characteristic curve (AUROC) of 0.84 in the internal validation, which outperformed all the traditional scoring systems. In the external validations, the AUROC was 0.87 in the MIMIC-IV database, better than all the traditional scoring systems; the AUROC was 0.83 in the eICU database, higher than the Simplified Acute Physiology Score III and Sequential Organ Failure Assessment (SOFA),equal to 0.83 of the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV), and the AUROC was 0.68 in the Zigong database, higher than those from the systemic inflammatory response syndrome and SOFA. Furthermore, the proposed model showed the best discriminatory and calibrated capabilities and had the best net benefit in each validation. Conclusions: The proposed algorithm based on XGBoost and SHAP-value feature selection had high performance in predicting the mortality of sepsis patients within 24 h of ICU admission.

Volume rendering produces informative two-dimensional (2D) images from a 3-dimensional (3D) volume. It highlights the region of interest and facilitates a good comprehension of the entire data set. However, volume rendering faces a few challenges. First, a high-dimensional transfer function is usually required to differentiate the target from its neighboring objects with subtle variance. Unfortunately, designing such a transfer function is a strenuously trial-and-error process. Second, manipulating/visualizing a 3D volume with a traditional 2D input/output device suffers dimensional limitations. To address all the challenges, we design NUI-VR $$^2$$2 , a natural user interface-enabled volume rendering system in the virtual reality space. NUI-VR $$^2$$2 marries volume rendering and interactive image segmentation. It transforms the original volume into a probability map with image segmentation. A simple linear transfer function will highlight the target well in the probability map. More importantly, we set the entire image segmentation and volume rendering pipeline in an immersive virtual reality environment with a natural user interface. NUI-VR $$^2$$2 eliminates the dimensional limitations in manipulating and perceiving 3D volumes and dramatically improves the user experience.

Acute kidney injury (AKI), a common condition on the intensive-care unit (ICU), is characterized by an abrupt decrease in kidney function within a few hours or days, leading to kidney failure or damage. Although AKI is associated with poor outcomes, current guidelines overlook the heterogeneity among patients with this condition. Identification of AKI subphenotypes could enable targeted interventions and a deeper understanding of the injury's pathophysiology. While previous approaches based on unsupervised representation learning have been used to identify AKI subphenotypes, these methods cannot assess time series or disease severity. In this study, we developed a data- and outcome-driven deep-learning (DL) approach to identify and analyze AKI subphenotypes with prognostic and therapeutic implications. Specifically, we developed a supervised long short-term memory (LSTM) autoencoder (AE) with the aim of extracting representation from time-series EHR data that were intricately correlated with mortality. Then, subphenotypes were identified via application of K-means. In two publicly available datasets, three distinct clusters were identified, characterized by mortality rates of 11.3%, 17.3%, and 96.2% in one dataset and 4.6%, 12.1%, and 54.6% in the other. Further analysis demonstrated that AKI subphenotypes identified by our proposed approach were statistically significant on several clinical characteristics and outcomes. In this study, our proposed approach could successfully cluster the AKI population in ICU settings into 3 distinct subphenotypes. Thus, such approach could potentially improve outcomes of AKI patients in the ICU, with better risk assessment and potentially better personalized treatment.

The exact definition of Acute kidney injury (AKI) for patients with traumatic brain injury (TBI) is unknown. To compare the power of the “Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease” (RIFLE), Acute Kidney Injury Network (AKIN), Creatinine kinetics (CK), and Kidney Disease Improving Global Outcomes (KDIGO) to determine AKI incidence/stage and their association with the in-hospital mortality rate of patients with TBI. This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012, and 1648 patients were included. The subjects in this study were assessed for the presence and stage of AKI using RIFLE, AKIN, CK, and KDIGO. In addition, the propensity score matching method was used. Among the 1648 patients, 291 (17.7%) had AKI, according to KDIGO. The highest incidence of AKI was found by KDIGO (17.7%), followed by AKIN (17.1%), RIFLE (12.7%), and CK (11.5%) (P = 0.97). Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3% for stage 0, 36.0%/91.5%/44.5% for stage 1, 35.9%/90.6%/11.3% for stage 2, and 47.4%/89.5%/36.8% for stage 3. The in-hospital mortality rates increased with the AKI stage in all four definitions. The severity of AKI by all definitions and stages was not associated with in-hospital mortality in the multivariable analyses (all P > 0.05). Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages. This study revealed that KDIGO is the best method to define AKI in patients with TBI.

Background: Acute kidney injury (AKI) is associated with increased mortality in critically ill patients. Due to differences in the etiology and pathophysiological mechanism, the current AKI criteria put it an embarrassment to evaluate clinical therapy and prognosis. Objective: We aimed to identify subphenotypes based on routinely collected clinical data to expose the unique pathophysiologic patterns. Methods: A retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD), and a deep clustering approach was conducted to derive subphenotypes. We conducted further analysis to uncover the underlying clinical patterns and interpret the subphenotype derivation. Results: We studied 14,189 and 19,382 patients with AKI within 48 h of ICU admission in the two datasets, respectively. Through our approach, we identified seven distinct AKI subphenotypes with mortality heterogeneity in each cohort. These subphenotypes displayed significant variations in demographics, comorbidities, levels of laboratory measurements, and survival patterns. Notably, the subphenotypes could not be effectively characterized using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria alone. Therefore, we uncovered the unique underlying characteristics of each subphenotype through model-based interpretation. To assess the usability of the subphenotypes, we conducted an evaluation, which yielded a micro-Area Under the Receiver Operating Characteristic (AUROC) of 0.81 in the single-center cohort and 0.83 in the multi-center cohort within 48-hour of admission. Conclusion: We derived highly characteristic, interpretable, and usable AKI subphenotypes that exhibited superior prognostic values.

The mortality rate in the intensive care unit (ICU) is a key metric of hospital clinical quality. To enhance hospital performance, many methods have been proposed for the stratification of patients' different risk categories, such as severity scoring systems and machine learning models. However, these methods make capturing time sequence information difficult, posing challenges to the continuous assessment of a patient's severity during their hospital stay. Therefore, we built a predictive model that can make predictions throughout the patient's stay and obtain the patient's risk of death in real time. Our proposed model performed much better than other machine learning methods, including logistic regression, random forest, and XGBoost, in a full set of performance evaluation processes. Thus, the proposed model can support physicians' decisions by allowing them to pay more attention to high-risk patients and anticipate potential complications to reduce ICU mortality.