Personalized ICU mortality assessment by interpretable machine learning algorithms in patients with sepsis combined lung cancer: a population-based study and an external validation cohort

Purpose Sepsis is a leading cause of mortality, especially among immunocompromised patients with lung cancer. We aimed to establish machine learning (ML) based model to accurately forecast ICU mortality in patients with sepsis combined lung cancer. Methods We incorporated patients with sepsis combined lung cancer from Medical Information Mart for Intensive Care IV (MIMIC IV) database. Univariate and multivariate logistic analysis were employed to select variables. Recursive Feature Elimination (RFE) method based on 6 ML algorithms was used for feature selection. We harnessed 13 ML algorithms to construct prediction model, which were assessed by area under the curve (AUC), accuracy, sensitivity, specificity, precision, cross-entropy and Brier scores. The best ML model was constructed to predict ICU mortality, and the predictive results were interpretated by SHapley Additive exPlanations (SHAP) framework. Results A sum of 1096 lung cancer patients combined sepsis from MIMIC IV database and 251 patients from the external validation set were included. We utilized 13 clinical variables to establish prediction model for ICU mortality. CatBoost model was identified as the prime prediction model with the highest AUC in the training (0.931 [0.921, 0.945]), internal validation (0.698 [0.673, 0.724]) and external validation (0.794 [0.725, 0.879]) cohorts. Oxford Acute Severity of Illness Score (OASIS) had the greatest influence on ICU mortality according to SHAP interpretation. Conclusions Our ML models demonstrate excellent accuracy and reliability, facilitating more rigorous personalized prognostic forecast to lung cancer patients combined sepsis.