Development of deep learning algorithm for detecting dyskalemia based on electrocardiogram

Abstract

Dyskalemia is a common electrolyte abnormality. Since dyskalemia can cause fatal arrhythmias and cardiac arrest in severe cases, it is crucial to monitor serum potassium (K⁺) levels on time. We developed deep learning models to detect hyperkalemia (K⁺ ≥ 5.5 mEq/L) and hypokalemia (K⁺ < 3.5 mEq/L) from electrocardiograms (ECGs), which are noninvasive and can be quickly measured. The retrospective cohort study was conducted at two hospitals from 2006 to 2020. The training set, validation set, internal testing cohort, and external validation cohort comprised 310,449, 15,828, 23,849, and 130,415 ECG-K⁺ samples, respectively. Deep learning models demonstrated high diagnostic performance in detecting hyperkalemia (AUROC 0.929, 0.912, 0.887 with sensitivity 0.926, 0.924, 0.907 and specificity 0.706, 0.676, 0.635 for 12-lead, limb-lead, lead I ECGs) and hypokalemia (AUROC 0.925, 0.896, 0.885 with sensitivity 0.912, 0.896, 0.904 and specificity 0.790, 0.734, 0.694) in the internal testing cohort. The group predicted to be positive by the hyperkalemia model showed a lower 30-day survival rate compared to the negative group (p < 0.001), supporting the clinical efficacy of the model. We also compared the importance of ECG segments (P, QRS, and T) on dyskalemia prediction of the model for interpretability. By applying these models in clinical practice, it will be possible to diagnose dyskalemia simply and quickly, thereby contributing to the improvement of patient outcomes.

Fig. 1

Study cohorts’ summary.

Fig. 2

Receiver Operating Characteristic (ROC) curve of DeepECG-Hyperkalemia and DeepECG-Hypokalemia in the Internal testing cohort (A,C, respectively) and the External validation cohort (B,D, respectively).

Fig. 3

(A) Kaplan–Meier curve for mortality at 30-day follow up according to the hyperkalemia (Total ECGs = 82,984). (B) Kaplan–Meier curve for mortality at 30-day follow up according to the DeepECG-Hyperkalemia diagnosis result. (C) Kaplan–Meier curve for mortality at 30-day follow up according to the DeepECG-Hyperkalemia diagnosis among patients with actual K⁺ more than 5.5 mEq/L—The patients classified as DeepECG-Hyperkalemia positive showed worse 30-day survival (Total ECGs = 82,320).