• Thomas Tschoellitsch, Philipp Moser, Alexander Maletzky, Philipp Seidl, Carl Böck, Theresa Roland, Helga Ludwig, Susanne Süssner, Sepp Hochreiter, and Jens Meier.
• From the Department of Anesthesiology and Critical Care Medicine, Kepler University, Hospital and Johannes Kepler University, Linz, Austria.
• Anesth. Analg. 2024 Mar 1; 138 (3): 645654645-654.

BackgroundTransfusion of packed red blood cells (pRBCs) is still associated with risks. This study aims to determine whether renal function deterioration in the context of individual transfusions in individual patients can be predicted using machine learning. Recipient and donor characteristics linked to increased risk are identified.MethodsThis study was registered at ClinicalTrials.gov (NCT05466370) and was conducted after local ethics committee approval. We evaluated 3366 transfusion episodes from a university hospital between October 31, 2016, and August 31, 2020. Random forest models were tuned and trained via Python auto-sklearn package to predict acute kidney injury (AKI). The models included recipients' and donors' demographic parameters and laboratory values, donor questionnaire results, and the age of the pRBCs. Bootstrapping on the test dataset was used to calculate the means and standard deviations of various performance metrics.ResultsAKI as defined by a modified Kidney Disease Improving Global Outcomes (KDIGO) criterion developed after 17.4% transfusion episodes (base rate). AKI could be predicted with an area under the curve of the receiver operating characteristic (AUC-ROC) of 0.73 ± 0.02. The negative (NPV) and positive (PPV) predictive values were 0.90 ± 0.02 and 0.32 ± 0.03, respectively. Feature importance and relative risk analyses revealed that donor features were far less important than recipient features for predicting posttransfusion AKI.ConclusionsSurprisingly, only the recipients' characteristics played a decisive role in AKI prediction. Based on this result, we speculate that the selection of a specific pRBC may have less influence than recipient characteristics.Copyright © 2023 International Anesthesia Research Society.

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