Derivation of an electronic frailty index for predicting short-term mortality in heart failure : a machine learning approach

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review

1 Scopus Citations
View graph of relations

Author(s)

  • Chengsheng Ju
  • Sharen Lee
  • Martin Sebastian Tan
  • Tong Liu
  • George Bazoukis
  • Kamalan Jeevaratnam
  • Esther W.Y. Chan
  • Ian Chi Kei Wong
  • Li Wei
  • Gary Tse

Related Research Unit(s)

Detail(s)

Original languageEnglish
Pages (from-to)2837-2845
Journal / PublicationESC heart failure
Volume8
Issue number4
Online published3 Jun 2021
Publication statusPublished - Aug 2021

Link(s)

Abstract

Aims: Frailty may be found in heart failure patients especially in the elderly and is associated with a poor prognosis. However, assessment of frailty status is time-consuming, and the electronic frailty indices developed using health records have served as useful surrogates. We hypothesized that an electronic frailty index developed using machine learning can improve short-term mortality prediction in patients with heart failure. 
Methods and results: This was a retrospective observational study that included patients admitted to nine public hospitals for heart failure from Hong Kong between 2013 and 2017. Age, sex, variables in the modified frailty index, Deyo's Charlson co-morbidity index (≥2), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index at baseline were analysed. Gradient boosting, which is a supervised sequential ensemble learning algorithm with weak prediction submodels (typically decision trees), was applied to predict mortality. Variables were ranked in the order of importance with a total score of 100 and used to build the frailty models. Comparisons were made with decision tree and multivariable logistic regression. A total of 8893 patients (median: age 81, Q1–Q3: 71–87 years old) were included, in whom 9% had 30 day mortality and 17% had 90 day mortality. Prognostic nutritional index, age, and NLR were the most important variables predicting 30 day mortality (importance score: 37.4, 32.1, and 20.5, respectively) and 90 day mortality (importance score: 35.3, 36.3, and 14.6, respectively). Gradient boosting significantly outperformed decision tree and multivariable logistic regression. The area under the curve from a five-fold cross validation was 0.90 for gradient boosting and 0.87 and 0.86 for decision tree and logistic regression in predicting 30 day mortality. For the prediction of 90 day mortality, the area under the curve was 0.92, 0.89, and 0.86 for gradient boosting, decision tree, and logistic regression, respectively. 
Conclusions: The electronic frailty index based on co-morbidities, inflammation, and nutrition information can readily predict mortality outcomes. Their predictive performances were significantly improved by gradient boosting techniques.

Research Area(s)

  • Frailty index, Heart failure, Inflammation, Machine learning, Mortality, Nutrition

Citation Format(s)

Derivation of an electronic frailty index for predicting short-term mortality in heart failure : a machine learning approach. / Ju, Chengsheng; Zhou, Jiandong; Lee, Sharen; Tan, Martin Sebastian; Liu, Tong; Bazoukis, George; Jeevaratnam, Kamalan; Chan, Esther W.Y.; Wong, Ian Chi Kei; Wei, Li; Zhang, Qingpeng; Tse, Gary.

In: ESC heart failure, Vol. 8, No. 4, 08.2021, p. 2837-2845.

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review

Download Statistics

No data available