Developing a predictive model for septic shock risk in acute pancreatitis patients using interpretable machine learning algorithms.

Background: Septic shock is a severe complication of acute pancreatitis (AP), often associated with poor prognosis. This study aims to analyze the clinical characteristics of patients with acute pancreatitis and develop an interpretable early prediction model for septic shock in these patients using machine learning (ML). The model is intended to assist emergency physicians in resource allocation and medical decision making.

Methods: Data were collected from the MIMIC-IV 3.0 database. The dataset was divided into a training set and a test set in a 7:3 ratio. Feature selection was performed using LASSO (Least Absolute Shrinkage and Selection Operator) regression. Subsequently, 10 ML models were developed: Random Forest, Logistic Regression, Gradient Boosting Machine, Neural Network, Extreme Gradient Boosting (XGBoost), K-Nearest Neighbor, Adaptive Boosting, Light Gradient Boosting Machine, Category Boosting, and Support Vector Machine. To enhance and optimize model interpretability, Shapley Additive Explanations (SHAP) were employed.

Results: A total of 1032 patients with AP were included in this study, from which 31 variables were selected for model development. By comparing the area under the receiver operating characteristic curve and decision curve analysis results between the training and test sets, the XGBoost model demonstrated a significant advantage over other models. SHAP analysis revealed that white blood cell count, total bilirubin (bilirubin total), and bicarbonate (HCO₃ ^-) levels were the three most critical risk factors for the development of septic shock in patients with AP.

Conclusion: ML approaches exhibited promising performance in predicting septic shock in patients with AP. These models may aid in guiding treatment decisions for patients with AP in the emergency department.