Improving preoperative risk-of-death prediction in surgery congenital heart defects using artificial intelligence model: A pilot study

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Chang Junior, Joao ; Binuesa, Fabio ; Caneo, Luiz Fernando ; Ribeiro Turquetto, Aida Luiza ; Trevisan Calvo Arita, Elisandra Cristina ; Barbosa, Aline Cristina ; da Silva Fernandes, Alfredo Manoel ; Trindade, Evelinda Marramon ; Jatene, Fabio Biscegli ; Dossou, Paul-Eric ; Jatene, Marcelo Biscegli

• Document type: Journal article
• Source: PLoS One; v. 15, n. 9, p. 21-pg., 2020-09-04.

Abstract

Background Congenital heart disease accounts for almost a third of all major congenital anomalies. Congenital heart defects have a significant impact on morbidity, mortality and health costs for children and adults. Research regarding the risk of pre-surgical mortality is scarce. Objectives Our goal is to generate a predictive model calculator adapted to the regional reality focused on individual mortality prediction among patients with congenital heart disease undergoing cardiac surgery. Methods Two thousand two hundred forty CHD consecutive patients' data from InCor's heart surgery program was used to develop and validate the preoperative risk-of-death prediction model of congenital patients undergoing heart surgery. There were six artificial intelligence models most cited in medical references used in this study: Multilayer Perceptron (MLP), Random Forest (RF), Extra Trees (ET), Stochastic Gradient Boosting (SGB), Ada Boost Classification (ABC) and Bag Decision Trees (BDT). Results The top performing areas under the curve were achieved using Random Forest (0.902). Most influential predictors included previous admission to ICU, diagnostic group, patient's height, hypoplastic left heart syndrome, body mass, arterial oxygen saturation, and pulmonary atresia. These combined predictor variables represent 67.8% of importance for the risk of mortality in the Random Forest algorithm. Conclusions The representativeness of "hospital death" is greater in patients up to 66 cm in height and body mass index below 13.0 for InCor's patients. The proportion of "hospital death" declines with the increased arterial oxygen saturation index. Patients with prior hospitalization before surgery had higher "hospital death" rates than who did not required such intervention. The diagnoses groups having the higher fatal outcomes probability are aligned with the international literature. A web application is presented where researchers and providers can calculate predicted mortality based on the CgntSCORE on any web browser or smartphone. (AU)

• FAPESP's process: 16/15039-8 - Assist study of the impact of risk factors on morbi-mortality of congenital heart diseases: comparison of risk strata when two international scores are applied to the public health system of São Paulo State
• Grantee: Marcelo Biscegli Jatene
• Support Opportunities: Research Grants - Research in Public Policies for the National Health Care System (PP-SUS)
• FAPESP's process: 17/26002-0 - Referential model for improving clinical and surgical procedures in patients with congenital heart diseases: management, optimization and technical aspects
• Grantee: João Chang Junior
• Support Opportunities: Regular Research Grants