A Machine Learning Sepsis Prediction Algorithm for Intended Intensive Care Unit Use (NAVOY Sepsis): Proof-of-Concept Study (Preprint)

Abstract

BACKGROUND Despite decades of research, sepsis remains a leading cause of mortality and morbidity in ICUs worldwide. The key to effective management and patient outcome is early detection, where no prospectively validated machine learning prediction algorithm is available for clinical use in Europe today. OBJECTIVE To develop a high-performance machine learning sepsis prediction algorithm based on routinely collected ICU data, designed to be implemented in Europe. METHODS The machine learning algorithm is developed using Convolutional Neural Network, based on the Massachusetts Institute of Technology Lab for Computational Physiology MIMIC-III Clinical Database, focusing on ICU patients aged 18 years or older. Twenty variables are used for prediction, on an hourly basis. Onset of sepsis is defined in accordance with the international Sepsis-3 criteria. RESULTS The developed algorithm NAVOY Sepsis uses 4 hours of input and can with high accuracy predict patients with high risk of developing sepsis in the coming hours. The prediction performance is superior to that of existing sepsis early warning scoring systems, and competes well with previously published prediction algorithms designed to predict sepsis onset in accordance with the Sepsis-3 criteria, as measured by the area under the receiver operating characteristics curve (AUROC) and the area under the precision-recall curve (AUPRC). NAVOY Sepsis yields AUROC = 0.90 and AUPRC = 0.62 for predictions up to 3 hours before sepsis onset. The predictive performance is externally validated on hold-out test data, where NAVOY Sepsis is confirmed to predict sepsis with high accuracy. CONCLUSIONS An algorithm with excellent predictive properties has been developed, based on variables routinely collected at ICUs. This algorithm is to be further validated in an ongoing prospective randomized clinical trial and will be CE marked as Software as a Medical Device, designed for commercial use in European ICUs.