A machine learning model for early and accurate prediction of overt disseminated intravascular coagulation before its progression to an overt stage

Yutaka Umemura; Naoki Okada; Hiroshi Ogura; Jun Oda; Satoshi Fujimi

doi:10.1016/j.rpth.2024.102519

A machine learning model for early and accurate prediction of overt disseminated intravascular coagulation before its progression to an overt stage

Res Pract Thromb Haemost. 2024 Jul 22;8(5):102519. doi: 10.1016/j.rpth.2024.102519. eCollection 2024 Jul.

Authors

Yutaka Umemura^{1

2}, Naoki Okada^{1

3}, Hiroshi Ogura², Jun Oda², Satoshi Fujimi¹

Affiliations

¹ Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
² Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
³ Division of Medical Informatics, Kyoto University Graduate School of Informatics, Kyoto, Japan.

Abstract

Background: Recent studies suggested an expected survival benefit associated with anticoagulant therapies for sepsis in patients with disseminated intravascular coagulation (DIC). However, anticoagulant therapies for overt DIC are no longer assumed to regulate pathologic progression as overt DIC is a late-phase coagulation disorder. Therefore, methods for early prediction of sepsis-induced DIC before its progression to an overt stage are strongly required.

Objectives: We aimed to develop a prediction model for overt DIC using machine learning.

Methods: This retrospective, observational study included adult septic patients without overt DIC. The objective variable was binary classification of whether patients developed overt DIC based on International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria. Explanatory variables were the baseline and time series data within 7 days from sepsis diagnosis. Light Gradient Boosted Machine method was used to construct the prediction model. For controls, we assessed sensitivity and specificity of Japanese Association for Acute Medicine DIC criteria and ISTH sepsis-induced coagulopathy criteria for subsequent onset of overt DIC.

Results: Among 912 patients with sepsis, 139 patients developed overt DIC within 7 days from diagnosis of sepsis. Sensitivity, specificity, and area under the receiver operating characteristic curve for predicting onset of overt DIC within 7 days were 84.4%, 87.5%, and 0.867 in the test cohort and 95.0%, 75.9%, and 0.851 in the validation cohort, respectively. Sensitivity and specificity by the diagnostic thresholds were 54.7% and 74.9% for Japanese Association for Acute Medicine DIC criteria and 63.3% and 71.9% for ISTH sepsis-induced coagulopathy criteria, respectively.

Conclusion: Compared with conventional DIC scoring systems, a machine learning model might exhibit higher prediction accuracy.

Keywords: biomarkers; diagnosis; disseminated intravascular coagulation; machine learning; sepsis.