A predictive model of death from cerebrovascular diseases in intensive care units

Abstract

Objective

This study aimed to explore the mortality prediction of patients with cerebrovascular diseases in the intensive care unit (ICU) by examining the important signals during different periods of admission in the ICU, which is considered one of the new topics in the medical field. Several approaches have been proposed for prediction in this area. Each of these methods has been able to predict mortality somewhat, but many of these techniques require recording a large amount of data from the patients, where recording all data is not possible in most cases; at the same time, this study focused only on heart rate variability (HRV) and systolic and diastolic blood pressure.

Methods

The ICU data used for the challenge were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) Clinical Database. The proposed algorithm was evaluated using data from 88 cerebrovascular ICU patients, 48 men and 40 women, during their first 48 hours of ICU stay. The electrocardiogram (ECG) signals are related to lead II, and the sampling frequency is 125 Hz. The time of admission and time of death are labeled in all data. In this study, the mortality prediction in patients with cerebral ischemia is evaluated using the features extracted from the return map generated by the signal of HRV and blood pressure. To predict the patient's future condition, the combination of features extracted from the return mapping generated by the HRV signal, such as angle (α), area (A), and various parameters generated by systolic and diastolic blood pressure, including $\text{DB}{P}_{\text{Max}-\text{Min}}$ $\text{SB}{P}_{\text{SD}}$ have been used. Also, to select the best feature combination, the genetic algorithm (GA) and mutual information (MI) methods were used. Paired sample t-test statistical analysis was used to compare the results of two episodes (death and non-death episodes). The P-value for detecting the significance level was considered less than 0.005.

Results

The results indicate that the new approach presented in this paper can be compared with other methods or leads to better results. The best combination of features based on GA to achieve maximum predictive accuracy was m (mean), $L_{\text{Mean}}$, A, SBP_SVMax, DBP_Max-Min. The accuracy, specificity, and sensitivity based on the best features obtained from GA were 97.7%, 98.9%, and 95.4% for cerebral ischemia disease with a prediction horizon of 0.5–1 hour before death. The d-factor for the best feature combination based on the GA model is less than 1 (d-factor = 0.95). Also, the bracketed by 95 percent prediction uncertainty (95PPU) (%) was obtained at 98.6.

Conclusion

The combination of HRV and blood pressure signals might increase the accuracy of the prediction of the death episode and reduce the minimum hospitalization time of the patient with cerebrovascular diseases to determine the future status.