Data mining using clinical physiology at discharge to predict ICU readmissions

摘要

Patient readmissions to intensive care units (ICUs) are associated with increased mortality, morbidity and costs. Current models for predicting ICU readmissions have moderate predictive value, and can utilize up to twelve variables that may be assessed at various points of the ICU inpatient stay. We postulate that greater predictive value can be achieved with fewer physiological variables, some of which can be assessed in the 24 h before discharge. A data mining approach combining fuzzy modeling with tree search feature selection was applied to a large retrospectively collected ICU database (MIMIC II), representing data from four different ICUs at Beth Israel Deaconess Medical Center, Boston. The goal was to predict ICU readmission between 24 and 72 h after ICU discharge. Fuzzy modeling combined with sequential forward selection was able to predict readmissions with an area under the receiver-operating curve (AUC) of 0.72 ± 0.04, a sensitivity of 0.68 ± 0.02 and a specificity of 0.73 ± 0.03. Variables selected as having the highest predictive power include mean heart rate, mean temperature, mean platelets, mean non-invasive arterial blood pressure (mean), mean spO2, and mean lactic acid, during the last 24 h before discharge. Collection of the six predictive variables selected is not complex in modern ICUs, and their assessment may help support the development of clinical management plans that potentially mitigate the risk of readmission.