In-Hospital Mortality Prediction in Patients Receiving Mechanical Ventilation in Taiwan

Abstract

Background Few studies have used pooled data for more than 2 years and few have analyzed data for patients receiving mechanical ventilation in Taiwan. Objective To validate the use of an artificial neural network model for predicting in-hospital mortality in patients receiving mechanical ventilation in Taiwan and to compare the predictive accuracy of the artificial neural network model with that of a logistic regression model. Methods Retrospective comparison of 1000 pairs of data sets processed by logistic regression and artificial neural network models based on initial clinical data for 213 945 patients receiving mechanical ventilation. For each pair of artificial neural network and logistic regression models, the area under the receiver operating characteristic curves, Hosmer-Lemeshow statistics, and accuracy rate were calculated and compared by using t tests. Global sensitivity analysis and sensitivity score approach were also used to assess the relative significance of input parameters in the system model and the relative importance of variables. Results Compared with the logistic regression model, the artificial neural network model had a better accuracy rate in 96.3% of cases, better Hosmer-Lemeshow statistics in 41.2% of cases, and a better area under the curve in 97.6% of cases. Hospital volume was the most influential (sensitive) variable affecting in-hospital mortality, followed by Charlson comorbidity index, length of stay, and hospital type. Conclusions Compared with the conventional logistic regression model, the artificial neural network model was more accurate in predicting in-hospital mortality and had higher overall performance indices.

Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

“…Annual increases in the prevalence of MV patients were observed during 2004–2009. The data also confirmed previous reports that MV treatment outcomes are associated with the following: age, gender, CCI score, teaching hospital, hospital level, hospital volume, physician volume, infectious and parasitic diseases, tumor, endocrine, nutritional, or metabolic diseases or immunity disorders, mental system and sensory organ diseases, circulatory system diseases, digestive system diseases, genitourinary system diseases, skin and subcutaneous tissue disorders, symptoms: signs and unexplained, and injury and poisoning [ 3 , 7 , 8 , 11 – 13 ]. Our findings highlight the continuing need for efforts to increase the efficiency of medical resource utilization, to improve clinical outcomes in this population, and to provide renewed justification for prioritizing acute respiratory failure and MV in national research and policy initiatives.…”

“…As in previous reports, our study also showed that LOS was significantly lower in patients treated in high-volume hospitals than in those treated in low-volume hospitals. Furthermore, advanced age reportedly has a strong positive association with a high CCI score and medical resource utilization and mortality rate tend to be higher in MV patients with several co-morbidities [ 7 , 16 ]. This may explain why the current study revealed long LOS, high hospital treatment cost and high mortality rates in MV patients aged 65 and over who had infectious and parasitic diseases, tumor, endocrine, nutritional, or metabolic diseases or immunity disorders, mental system and sensory organ diseases, circulatory system diseases, digestive system diseases, genitourinary system diseases, skin and subcutaneous tissue disorders, symptoms: signs and unexplained, or injury and poisoning.…”

“…Apparently, the percentage of MV patients treated at high-volume hospitals during the same time period was higher in Taiwan than in the United States. The potential benefits of MV observed in the elderly patients analyzed in the current study may impact the management and treatment approaches applied in other countries where medical teams are adequately equipped and trained to perform MV treatment [ 1 , 7 ]. Improved medical techniques and recent advances in medical technology may explain the progressively improving outcomes reported in the literature [ 1 , 19 , 20 ].…”

“…The analysis included records for patients who had received an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for MV (96.70, period of ventilation unspecified; 96.71, ventilated for less than 96 hours; 96.72, ventilated for longer than 96 hours). The assessment was limited to patients who had received ventilation for longer than 96 hours [ 7 ]. The purposes of this criterion were to limit the analysis to patients with treatment times sufficiently long to evaluate overall patient care management techniques and practice patterns and to increase the homogeneity of the studied patient population among different facilities and over time [ 8 ].…”

Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study

“…One study reported that women had a greater risk for in-hospital mortality [ 35 ], but another reported no such association [ 30 ]. In contrast, two large studies showed that being male predicted higher in-hospital mortality in patients treated with MV [ 36 , 37 ]. Our study showed no significant differences in survival between the sexes, but the difference was significant after bias had been adjusted for.…”