• Lasith Adhikari, Tezcan Ozrazgat-Baslanti, Matthew Ruppert, R W M A Madushani, Srajan Paliwal, Haleh Hashemighouchani, Feng Zheng, Ming Tao, Juliano M Lopes, Xiaolin Li, Parisa Rashidi, and Azra Bihorac.
• Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL, United States of America.
• Plos One. 2019 Jan 1; 14 (4): e0214904.

BackgroundAcute kidney injury (AKI) is a common complication after surgery that is associated with increased morbidity and mortality. The majority of existing perioperative AKI risk prediction models are limited in their generalizability and do not fully utilize intraoperative physiological time-series data. Thus, there is a need for intelligent, accurate, and robust systems to leverage new information as it becomes available to predict the risk of developing postoperative AKI.MethodsA retrospective single-center cohort of 2,911 adults who underwent surgery at the University of Florida Health between 2000 and 2010 was utilized for this study. Machine learning and statistical analysis techniques were used to develop perioperative models to predict the risk of developing AKI during the first three days after surgery, first seven days after surgery, and overall (after surgery during the index hospitalization). The improvement in risk prediction was examined by incorporating intraoperative physiological time-series variables. Our proposed model enriched a preoperative model that produced a probabilistic AKI risk score by integrating intraoperative statistical features through a machine learning stacking approach inside a random forest classifier. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and Net Reclassification Improvement (NRI).ResultsThe predictive performance of the proposed model is better than the preoperative data only model. The proposed model had an AUC of 0.86 (accuracy of 0.78) for the seven-day AKI outcome, while the preoperative model had an AUC of 0.84 (accuracy of 0.76). Furthermore, by integrating intraoperative features, the algorithm was able to reclassify 40% of the false negative patients from the preoperative model. The NRI for each outcome was AKI at three days (8%), seven days (7%), and overall (4%).ConclusionsPostoperative AKI prediction was improved with high sensitivity and specificity through a machine learning approach that dynamically incorporated intraoperative data.

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