Utilization of Deep Learning for Subphenotype Identification in Sepsis-Associated Acute Kidney Injury

急性肾损伤 败血症 医学 透析 急诊科 内科学 重症监护室 重症监护医学 急诊医学 精神科
作者
Kumardeep Chaudhary,Akhil Vaid,Áine Duffy,Ishan Paranjpe,Suraj K. Jaladanki,Manish Paranjpe,Kipp W. Johnson,Avantee V. Gokhale,Pattharawin Pattharanitima,Kinsuk Chauhan,Ross O’Hagan,Tielman Van Vleck,Steven G. Coca,Richard Cooper,Benjamin S. Glicksberg,Erwin P. Böttinger,Lili Chan,Girish N. Nadkarni
出处
期刊:Clinical Journal of The American Society of Nephrology [Lippincott Williams & Wilkins]
卷期号:15 (11): 1557-1565 被引量:89
标识
DOI:10.2215/cjn.09330819
摘要

Sepsis-associated AKI is a heterogeneous clinical entity. We aimed to agnostically identify sepsis-associated AKI subphenotypes using deep learning on routinely collected data in electronic health records.We used the Medical Information Mart for Intensive Care III database, which consists of electronic health record data from intensive care units in a tertiary care hospital in the United States. We included patients ≥18 years with sepsis who developed AKI within 48 hours of intensive care unit admission. We then used deep learning to utilize all available vital signs, laboratory measurements, and comorbidities to identify subphenotypes. Outcomes were mortality 28 days after AKI and dialysis requirement.We identified 4001 patients with sepsis-associated AKI. We utilized 2546 combined features for K-means clustering, identifying three subphenotypes. Subphenotype 1 had 1443 patients, and subphenotype 2 had 1898 patients, whereas subphenotype 3 had 660 patients. Subphenotype 1 had the lowest proportion of liver disease and lowest Simplified Acute Physiology Score II scores compared with subphenotypes 2 and 3. The proportions of patients with CKD were similar between subphenotypes 1 and 3 (15%) but highest in subphenotype 2 (21%). Subphenotype 1 had lower median bilirubin levels, aspartate aminotransferase, and alanine aminotransferase compared with subphenotypes 2 and 3. Patients in subphenotype 1 also had lower median lactate, lactate dehydrogenase, and white blood cell count than patients in subphenotypes 2 and 3. Subphenotype 1 also had lower creatinine and BUN than subphenotypes 2 and 3. Dialysis requirement was lowest in subphenotype 1 (4% versus 7% [subphenotype 2] versus 26% [subphenotype 3]). The mortality 28 days after AKI was lowest in subphenotype 1 (23% versus 35% [subphenotype 2] versus 49% [subphenotype 3]). After adjustment, the adjusted odds ratio for mortality for subphenotype 3, with subphenotype 1 as a reference, was 1.9 (95% confidence interval, 1.5 to 2.4).Utilizing routinely collected laboratory variables, vital signs, and comorbidities, we were able to identify three distinct subphenotypes of sepsis-associated AKI with differing outcomes.
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