• Dominik Schulz, Sebastian Rasch, Markus Heilmaier, Rami Abbassi, Alexander Poszler, Jörg Ulrich, Manuel Steinhardt, Georgios A Kaissis, Roland M Schmid, Rickmer Braren, and Tobias Lahmer.
• Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany. Dominik.Schulz@uk-augsburg.de.
• Crit Care. 2023 May 26; 27 (1): 201201.

BackgroundA quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. A quantitative surrogate measure, although invasive, for pulmonary edema is the extravascular lung water index (EVLWI) extracted from the transpulmonary thermodilution (TPTD). Severity of edema from chest X-rays, to date is based on the subjective classification of radiologists. In this work, we use machine learning to quantitatively predict the severity of pulmonary edema from chest radiography.MethodsWe retrospectively included 471 X-rays from 431 patients who underwent chest radiography and TPTD measurement within 24 h at our intensive care unit. The EVLWI extracted from the TPTD was used as a quantitative measure for pulmonary edema. We used a deep learning approach and binned the data into two, three, four and five classes increasing the resolution of the EVLWI prediction from the X-rays.ResultsThe accuracy, area under the receiver operating characteristic curve (AUROC) and Mathews correlation coefficient (MCC) in the binary classification models (EVLWI < 15, ≥ 15) were 0.93 (accuracy), 0.98 (AUROC) and 0.86(MCC). In the three multiclass models, the accuracy ranged between 0.90 and 0.95, the AUROC between 0.97 and 0.99 and the MCC between 0.86 and 0.92.ConclusionDeep learning can quantify pulmonary edema as measured by EVLWI with high accuracy.© 2023. The Author(s).

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