Machine learning-based prediction of transfusion

Abstract

Background: The ability to predict transfusions arising during hospital admission might enable economized blood supply management and might furthermore increase patient safety by ensuring a sufficient stock of red blood cells (RBCs) for a specific patient. We therefore investigated the precision of four different machine learning-based prediction algorithms to predict transfusion, massive transfusion, and the number of transfusions in patients admitted to a hospital.

Study design and methods: This was a retrospective, observational study in three adult tertiary care hospitals in Western Australia between January 2008 and June 2017. Primary outcome measures for the classification tasks were the area under the curve for the receiver operating characteristics curve, the F₁ score, and the average precision of the four machine learning algorithms used: neural networks (NNs), logistic regression (LR), random forests (RFs), and gradient boosting (GB) trees.

Results: Using our four predictive models, transfusion of at least 1 unit of RBCs could be predicted rather accurately (sensitivity for NN, LR, RF, and GB: 0.898, 0.894, 0.584, and 0.872, respectively; specificity: 0.958, 0.966, 0.964, 0.965). Using the four methods for prediction of massive transfusion was less successful (sensitivity for NN, LR, RF, and GB: 0.780, 0.721, 0.002, and 0.797, respectively; specificity: 0.994, 0.995, 0.993, 0.995). As a consequence, prediction of the total number of packed RBCs transfused was also rather inaccurate.

Conclusion: This study demonstrates that the necessity for intrahospital transfusion can be forecasted reliably, however the amount of RBC units transfused during a hospital stay is more difficult to predict.

FIGURE 1

Transfusion of at least 1 RBC unit. Transfusion of at least 1 RBC unit. A, ROC curves for the different methods. B, Precision‐recall curve for the different methods [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Massive transfusion. Prediction of massive transfusion. A, ROC curves for the different methods. B, Precision‐recall curve for the different methods [Color figure can be viewed at wileyonlinelibrary.com]