A scoping review of machine learning for sepsis prediction- feature engineering strategies and model performance: a step towards explainability

Abstract

Background: Sepsis, an acute and potentially fatal systemic response to infection, significantly impacts global health by affecting millions annually. Prompt identification of sepsis is vital, as treatment delays lead to increased fatalities through progressive organ dysfunction. While recent studies have delved into leveraging Machine Learning (ML) for predicting sepsis, focusing on aspects such as prognosis, diagnosis, and clinical application, there remains a notable deficiency in the discourse regarding feature engineering. Specifically, the role of feature selection and extraction in enhancing model accuracy has been underexplored.

Objectives: This scoping review aims to fulfill two primary objectives: To identify pivotal features for predicting sepsis across a variety of ML models, providing valuable insights for future model development, and To assess model efficacy through performance metrics including AUROC, sensitivity, and specificity.

Results: The analysis included 29 studies across diverse clinical settings such as Intensive Care Units (ICU), Emergency Departments, and others, encompassing 1,147,202 patients. The review highlighted the diversity in prediction strategies and timeframes. It was found that feature extraction techniques notably outperformed others in terms of sensitivity and AUROC values, thus indicating their critical role in improving sepsis prediction models.

Conclusion: Key dynamic indicators, including vital signs and critical laboratory values, are instrumental in the early detection of sepsis. Applying feature selection methods significantly boosts model precision, with models like Random Forest and XG Boost showing promising results. Furthermore, Deep Learning models (DL) reveal unique insights, spotlighting the pivotal role of feature engineering in sepsis prediction, which could greatly benefit clinical practice.

Keywords: Clinical outcome; Critical features; Feature engineering; Machine learning; Performance evaluation; Scoping review; Sepsis prediction.

Fig. 1

Preferred Reporting Items for Scoping reviews and Meta-Analysis (PRISMA) flow diagram for the conducted study

Fig. 2

Database sources used in the studies

Fig. 3

Classification of feature selection methods

Fig. 4

Frequency of features identified in studies

Fig. 5

Performance analysis of different feature selection and extraction methods across open database

Fig. 6

Predicting the performance of multi-time window