Factor analysis based on SHapley Additive exPlanations for sepsis-associated encephalopathy in ICU mortality prediction using XGBoost - a retrospective study based on two large database

Jiayu Guo; Hongtao Cheng; Zicheng Wang; Mengmeng Qiao; Jing Li; Jun Lyu

doi:10.3389/fneur.2023.1290117

Factor analysis based on SHapley Additive exPlanations for sepsis-associated encephalopathy in ICU mortality prediction using XGBoost - a retrospective study based on two large database

Front Neurol. 2023 Dec 14:14:1290117. doi: 10.3389/fneur.2023.1290117. eCollection 2023.

Authors

Jiayu Guo^#^{1

2}, Hongtao Cheng^#^{1

3}, Zicheng Wang¹, Mengmeng Qiao^{1

2}, Jing Li^{1

2}, Jun Lyu^{1

4}

Affiliations

¹ Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
² School of Public Health, Shannxi University of Chinese Medicine, Xianyang, China.
³ School of Nursing, Jinan University, Guangzhou, Guangdong, China.
⁴ Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China.

^# Contributed equally.

Abstract

Objective: Sepsis-associated encephalopathy (SAE) is strongly linked to a high mortality risk, and frequently occurs in conjunction with the acute and late phases of sepsis. The objective of this study was to construct and verify a predictive model for mortality in ICU-dwelling patients with SAE.

Methods: The study selected 7,576 patients with SAE from the MIMIC-IV database according to the inclusion criteria and randomly divided them into training (n = 5,303, 70%) and internal validation (n = 2,273, 30%) sets. According to the same criteria, 1,573 patients from the eICU-CRD database were included as an external test set. Independent risk factors for ICU mortality were identified using Extreme Gradient Boosting (XGBoost) software, and prediction models were constructed and verified using the validation set. The receiver operating characteristic (ROC) and the area under the ROC curve (AUC) were used to evaluate the discrimination ability of the model. The SHapley Additive exPlanations (SHAP) approach was applied to determine the Shapley values for specific patients, account for the effects of factors attributed to the model, and examine how specific traits affect the output of the model.

Results: The survival rate of patients with SAE in the MIMIC-IV database was 88.6% and that of 1,573 patients in the eICU-CRD database was 89.1%. The ROC of the XGBoost model indicated good discrimination. The AUCs for the training, test, and validation sets were 0.908, 0.898, and 0.778, respectively. The impact of each parameter on the XGBoost model was depicted using a SHAP plot, covering both positive (acute physiology score III, vasopressin, age, red blood cell distribution width, partial thromboplastin time, and norepinephrine) and negative (Glasgow Coma Scale) ones.

Conclusion: A prediction model developed using XGBoost can accurately predict the ICU mortality of patients with SAE. The SHAP approach can enhance the interpretability of the machine-learning model and support clinical decision-making.

Keywords: ICU mortality; MIMIC-IV; SHAP (SHapley Additive exPlanations); XGBoost; eICU-CRD; sepsis-associated encephalopathy (SAE).

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The work was supported by Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization (2021B1212040007), the Clinical Frontier Technology Program of the First Affiliated Hospital of Jinan University, China (No. JNU1AF-CFTP-2022-a01235), and the Science and Technology Projects in Guangzhou, China (Nos. 202201020054 and 2023A03J1032).