Predicting sepsis in multi-site, multi-national intensive care cohorts using deep learning
This work addresses the critical need for timely sepsis management to reduce mortality and morbidity in ICU patients, representing an incremental improvement with a novel method applied to a large, harmonized dataset.
The researchers tackled the problem of early sepsis prediction in ICU patients by developing a deep learning model, achieving an AUROC of 0.847 in internal validation and 0.761 in external validation, with the model detecting sepsis 3.7 hours in advance at 80% recall and 39% precision.
Despite decades of clinical research, sepsis remains a global public health crisis with high mortality, and morbidity. Currently, when sepsis is detected and the underlying pathogen is identified, organ damage may have already progressed to irreversible stages. Effective sepsis management is therefore highly time-sensitive. By systematically analysing trends in the plethora of clinical data available in the intensive care unit (ICU), an early prediction of sepsis could lead to earlier pathogen identification, resistance testing, and effective antibiotic and supportive treatment, and thereby become a life-saving measure. Here, we developed and validated a machine learning (ML) system for the prediction of sepsis in the ICU. Our analysis represents the largest multi-national, multi-centre in-ICU study for sepsis prediction using ML to date. Our dataset contains $156,309$ unique ICU admissions, which represent a refined and harmonised subset of five large ICU databases originating from three countries. Using the international consensus definition Sepsis-3, we derived hourly-resolved sepsis label annotations, amounting to $26,734$ ($17.1\%$) septic stays. We compared our approach, a deep self-attention model, to several clinical baselines as well as ML baselines and performed an extensive internal and external validation within and across databases. On average, our model was able to predict sepsis with an AUROC of $0.847 \pm 0.050$ (internal out-of sample validation) and $0.761 \pm 0.052$ (external validation). For a harmonised prevalence of $17\%$, at $80\%$ recall our model detects septic patients with $39\%$ precision 3.7 hours in advance.