RT Journal Article
SR Electronic
T1 Deep Learning Model for Real-Time Prediction of Intradialytic Hypotension
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP 396
OP 406
DO 10.2215/CJN.09280620
VO 16
IS 3
A1 Lee, Hojun
A1 Yun, Donghwan
A1 Yoo, Jayeon
A1 Yoo, Kiyoon
A1 Kim, Yong Chul
A1 Kim, Dong Ki
A1 Oh, Kook-Hwan
A1 Joo, Kwon Wook
A1 Kim, Yon Su
A1 Kwak, Nojun
A1 Han, Seung Seok
YR 2021
UL http://cjasn.asnjournals.org/content/16/3/396.abstract
AB Background and objectives Intradialytic hypotension has high clinical significance. However, predicting it using conventional statistical models may be difficult because several factors have interactive and complex effects on the risk. Herein, we applied a deep learning model (recurrent neural network) to predict the risk of intradialytic hypotension using a timestamp-bearing dataset.Design, setting, participants, & measurements We obtained 261,647 hemodialysis sessions with 1,600,531 independent timestamps (i.e., time-varying vital signs) and randomly divided them into training (70%), validation (5%), calibration (5%), and testing (20%) sets. Intradialytic hypotension was defined when nadir systolic BP was <90 mm Hg (termed intradialytic hypotension 1) or when a decrease in systolic BP ≥20 mm Hg and/or a decrease in mean arterial pressure ≥10 mm Hg on the basis of the initial BPs (termed intradialytic hypotension 2) or prediction time BPs (termed intradialytic hypotension 3) occurred within 1 hour. The area under the receiver operating characteristic curves, the area under the precision-recall curves, and F1 scores obtained using the recurrent neural network model were compared with those obtained using multilayer perceptron, Light Gradient Boosting Machine, and logistic regression models.Results The recurrent neural network model for predicting intradialytic hypotension 1 achieved an area under the receiver operating characteristic curve of 0.94 (95% confidence intervals, 0.94 to 0.94), which was higher than those obtained using the other models (P<0.001). The recurrent neural network model for predicting intradialytic hypotension 2 and intradialytic hypotension 3 achieved area under the receiver operating characteristic curves of 0.87 (interquartile range, 0.87–0.87) and 0.79 (interquartile range, 0.79–0.79), respectively, which were also higher than those obtained using the other models (P≤0.001). The area under the precision-recall curve and F1 score were higher using the recurrent neural network model than they were using the other models. The recurrent neural network models for intradialytic hypotension were highly calibrated.Conclusions Our deep learning model can be used to predict the real-time risk of intradialytic hypotension.