Real-world databases often contain missing data and existing correction algorithms deliver varying performance. Also, most modeling techniques are not suitable to deal with them automatically. In this study we examine different approaches to predicting septic shock in the presence of missing data. Some preprocessing techniques for managing missing data include disregarding data, or replacing it with information that by design introduces bias. In this study, we show that predictive performance improves by employing a minimum pre-processing technique, the Zero-Order-Hold (ZOH) method, by applying a Fuzzy C-Means clustering technique based on the partial distance calculation strategy (FCM-PDS) and by computing the final classification regarding the samples from each patient. Performance improvements continue to occur where up to approximately 60% of the data is missing, though for higher percentage the classification performance still is statistically improved. We further validate this approach by making comparisons with previous studies.

Left ventricular ejection fraction (LVEF) constitutes an important physiological parameter for the assessment of cardiac function, particularly in the settings of coronary artery disease and heart failure. This study explores the use of routinely and easily acquired variables in the intensive care unit (ICU) to predict severely depressed LVEF following ICU admission. A retrospective study was conducted. We extracted clinical physiological variables derived from ICU monitoring and available within the MIMIC II database and developed a fuzzy model using sequential feature selection and compared it with the conventional logistic regression (LR) model. Maximum predictive performance was observed using easily acquired ICU variables within 6 hours after admission and satisfactory predictive performance was achieved using variables acquired as early as one hour after admission. The fuzzy model is able to predict LVEF ≤ 25% with an AUC of 0.71 ± 0.07, outperforming the LR model, with an AUC of 0.67 ± 0.07. To the best of the authors' knowledge, this is the first study predicting severely impaired LVEF using multivariate analysis of routinely collected data in the ICU. We recommend inclusion of these findings into triaged management plans that balance urgency with resources and clinical status, particularly for reducing the time of echocardiographic examination.