Construction and validation of a machine learning-based prediction model for short-term mortality in critically ill patients with liver cirrhosis

Objective

Critically ill patients with liver cirrhosis generally have a poor prognosis due to complications such as multiple organ failure. This study aims to develop a machine learning-based prediction model to forecast short-term mortality in critically ill cirrhotic patients in the intensive care unit (ICU), thereby assisting clinical decision-making for intervention and treatment.

Methods

Machine learning models were developed using clinical data from critically ill cirrhotic patients in the MIMIC database, with multicenter validation performed using data from the eICU database and Qinghai University Affiliated Hospital(QUAH). Various machine learning models, including a Stacking ensemble model, were employed, with the SHAP method used to enhance model interpretability.

Results

The Stacking ensemble model demonstrated superior predictive performance through internal and external validation, with AUC and AP values surpassing those of individual algorithms. The AUC values were 0.845 in the internal validation set, 0.819 in the eICU external validation, and 0.761 in the QUAH validation set. Additionally, the SHAP method highlighted key prognostic variables such as INR, bilirubin, and urine output. The model was ultimately deployed as a web-based calculator for bedside decision-making.

Conclusion

The machine learning model effectively predicts short-term mortality risk in critically ill cirrhotic patients in the ICU, showing strong predictive performance and generalizability. The model's robust interpretability and its deployment as a web-based calculator suggest its potential as a valuable tool for assessing the prognosis of cirrhotic patients.