Predicting ICU Mortality in Acute Respiratory Distress Syndrome Patients Using Machine Learning: The Predicting Outcome and STratifiCation of severity in ARDS (POSTCARDS) Study.

To assess the value of machine learning approaches in the development of a multivariable model for early prediction of ICU death in patients with acute respiratory distress syndrome (ARDS). A development, testing, and external validation study using clinical data from four prospective, multicenter, observational cohorts. A network of multidisciplinary ICUs. A total of 1,303 patients with moderate-to-severe ARDS managed with lung-protective ventilation. None. We developed and tested prediction models in 1,000 ARDS patients. We performed logistic regression analysis following variable selection by a genetic algorithm, random forest and extreme gradient boosting machine learning techniques. Potential predictors included demographics, comorbidities, ventilatory and oxygenation descriptors, and extrapulmonary organ failures. Risk modeling identified some major prognostic factors for ICU mortality, including age, cancer, immunosuppression, Pa o2 /F io2 , inspiratory plateau pressure, and number of extrapulmonary organ failures. Together, these characteristics contained most of the prognostic information in the first 24 hours to predict ICU mortality. Performance with machine learning methods was similar to logistic regression (area under the receiver operating characteristic curve [AUC], 0.87; 95% CI, 0.82-0.91). External validation in an independent cohort of 303 ARDS patients confirmed that the performance of the model was similar to a logistic regression model (AUC, 0.91; 95% CI, 0.87-0.94). Both machine learning and traditional methods lead to promising models to predict ICU death in moderate/severe ARDS patients. More research is needed to identify markers for severity beyond clinical determinants, such as demographics, comorbidities, lung mechanics, oxygenation, and extrapulmonary organ failure to guide patient management.

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Drs. Martín-Rodríguez and Rodríguez-Suárez received support for article research from the National Institutes of Health. Dr. Rodríguez-Suárez disclosed work for government. Dr. Szakmany received funding from PAION UK and Thermo Fisher UK; he disclosed that they are a trustee of Intensive Care National Audit & Research Centre and an Associate Editor for Social Media for Critical Care Explorations. Dr. Slutsky received funding from Signal-1. Dr. Villar, Dr. Añón, Dr. Ferrando, Ms. Fernández, and Dr. González-Martin received grant support from the Instituto de Salud Carlos III, Madrid, Spain (CB06/06/1088). Dr. Hernández-González is a Serra Húnter fellow. Dr. Slutsky was funded by the Canadian Institutes of Health Research (grants numbers 137772 and FDN143285). The remaining authors have disclosed that they do not have any potential conflicts of interest.