Prediction of Acute Respiratory Distress Syndrome in Traumatic Brain Injury Patients Based on Machine Learning Algorithms

Background: Acute respiratory distress syndrome (ARDS) commonly develops in traumatic brain injury (TBI) patients and is a risk factor for poor prognosis. We designed this study to evaluate the performance of several machine learning algorithms for predicting ARDS in TBI patients. Methods: TBI patients from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were eligible for this study. ARDS was identified according to the Berlin definition. Included TBI patients were divided into the training cohort and the validation cohort with a ratio of 7:3. Several machine learning algorithms were utilized to develop predictive models with five-fold cross validation for ARDS including extreme gradient boosting, light gradient boosting machine, Random Forest, adaptive boosting, complement naive Bayes, and support vector machine. The performance of machine learning algorithms were evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy and F score. Results: 649 TBI patients from the MIMIC-III database were included with an ARDS incidence of 49.5%. The random forest performed the best in predicting ARDS in the training cohort with an AUC of 1.000. The XGBoost and AdaBoost ranked the second and the third with an AUC of 0.989 and 0.815 in the training cohort. The random forest still performed the best in predicting ARDS in the validation cohort with an AUC of 0.652. AdaBoost and XGBoost ranked the second and the third with an AUC of 0.631 and 0.620 in the validation cohort. Several mutual top features in the random forest and AdaBoost were discovered including age, initial systolic blood pressure and heart rate, Abbreviated Injury Score chest, white blood cells, platelets, and international normalized ratio. Conclusions: The random forest and AdaBoost based models have stable and good performance for predicting ARDS in TBI patients. These models could help clinicians to evaluate the risk of ARDS in early stages after TBI and consequently adjust treatment decisions.