Fast and Interpretable Mortality Risk Scores for Critical Care Patients

TL;DR

This paper introduces GroupFasterRisk, an interpretable machine learning algorithm that creates sparse, accurate, and flexible mortality risk scores for ICU patients, outperforming traditional scores and matching black box models.

Contribution

The paper presents a novel algorithm, GroupFasterRisk, which produces interpretable, sparse, and accurate mortality risk scores, incorporating domain knowledge and offering multiple model options.

Findings

GroupFasterRisk outperforms OASIS and SAPS II scores.

Models are as accurate as APACHE IV/IVa with fewer parameters.

Better performance on specific conditions like sepsis and heart failure.

Abstract

Prediction of mortality in intensive care unit (ICU) patients typically relies on black box models (that are unacceptable for use in hospitals) or hand-tuned interpretable models (that might lead to the loss in performance). We aim to bridge the gap between these two categories by building on modern interpretable ML techniques to design interpretable mortality risk scores that are as accurate as black boxes. We developed a new algorithm, GroupFasterRisk, which has several important benefits: it uses both hard and soft direct sparsity regularization, it incorporates group sparsity to allow more cohesive models, it allows for monotonicity constraint to include domain knowledge, and it produces many equally-good models, which allows domain experts to choose among them. For evaluation, we leveraged the largest existing public ICU monitoring datasets (MIMIC III and eICU). Models produced by GroupFasterRisk outperformed OASIS and SAPS II scores and performed similarly to APACHE IV/IVa while using at most a third of the parameters. For patients with sepsis/septicemia, acute myocardial infarction, heart failure, and acute kidney failure, GroupFasterRisk models outperformed OASIS and SOFA. Finally, different mortality prediction ML approaches performed better based on variables selected by GroupFasterRisk as compared to OASIS variables. GroupFasterRisk's models performed better than risk scores currently used in hospitals, and on par with black box ML models, while being orders of magnitude sparser. Because GroupFasterRisk produces a variety of risk scores, it allows design flexibility - the key enabler of practical model creation. GroupFasterRisk is a fast, accessible, and flexible procedure that allows learning a diverse set of sparse risk scores for mortality prediction.