Multitask Learning With Recurrent Neural Networks for Acute Respiratory Distress Syndrome Prediction Using Only Electronic Health Record Data: Model Development and Validation Study

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a condition that is often considered to have broad and subjective diagnostic criteria and is associated with significant mortality and morbidity. Early and accurate prediction of ARDS and related conditions such as hypoxemia and sepsis could allow timely administration of therapies, leading to improved patient outcomes.

Objective: The aim of this study is to perform an exploration of how multilabel classification in the clinical setting can take advantage of the underlying dependencies between ARDS and related conditions to improve early prediction of ARDS in patients.

Methods: The electronic health record data set included 40,703 patient encounters from 7 hospitals from April 20, 2018, to March 17, 2021. A recurrent neural network (RNN) was trained using data from 5 hospitals, and external validation was conducted on data from 2 hospitals. In addition to ARDS, 12 target labels for related conditions such as sepsis, hypoxemia, and COVID-19 were used to train the model to classify a total of 13 outputs. As a comparator, XGBoost models were developed for each of the 13 target labels. Model performance was assessed using the area under the receiver operating characteristic curve. Heat maps to visualize attention scores were generated to provide interpretability to the neural networks. Finally, cluster analysis was performed to identify potential phenotypic subgroups of patients with ARDS.

Results: The single RNN model trained to classify 13 outputs outperformed the individual XGBoost models for ARDS prediction, achieving an area under the receiver operating characteristic curve of 0.842 on the external test sets. Models trained on an increasing number of tasks resulted in improved performance. Earlier prediction of ARDS nearly doubled the rate of in-hospital survival. Cluster analysis revealed distinct ARDS subgroups, some of which had similar mortality rates but different clinical presentations.

Conclusions: The RNN model presented in this paper can be used as an early warning system to stratify patients who are at risk of developing one of the multiple risk outcomes, hence providing practitioners with the means to take early action.

Keywords: ARDS; COVID-19; clinical decision support; deep learning; diagnostic criteria; electronic health record; health care; multitask learning; neural networks; prediction model; recurrent neural network; respiratory distress; risk outcome.