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Developing machine learning models to predict multi-class functional outcomes and death three months after stroke in Sweden

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  • Josline Adhiambo Otieno
  • Jenny Häggström
  • David Darehed
  • Marie Eriksson

Abstract

Globally, stroke is the third-leading cause of mortality and disability combined, and one of the costliest diseases in society. More accurate predictions of stroke outcomes can guide healthcare organizations in allocating appropriate resources to improve care and reduce both the economic and social burden of the disease. We aim to develop and evaluate the performance and explainability of three supervised machine learning models and the traditional multinomial logistic regression (mLR) in predicting functional dependence and death three months after stroke, using routinely-collected data. This prognostic study included adult patients, registered in the Swedish Stroke Registry (Riksstroke) from 2015 to 2020. Riksstroke contains information on stroke care and outcomes among patients treated in hospitals in Sweden. Prognostic factors (features) included demographic characteristics, pre-stroke functional status, cardiovascular risk factors, medications, acute care, stroke type, and severity. The outcome was measured using the modified Rankin Scale at three months after stroke (a scale of 0–2 indicates independent, 3–5 dependent, and 6 dead). Outcome prediction models included support vector machines, artificial neural networks (ANN), eXtreme Gradient Boosting (XGBoost), and mLR. The models were trained and evaluated on 75% and 25% of the dataset, respectively. Model predictions were explained using SHAP values. The study included 102,135 patients (85.8% ischemic stroke, 53.3% male, mean age 75.8 years, and median NIHSS of 3). All models demonstrated similar overall accuracy (69%–70%). The ANN and XGBoost models performed significantly better than the mLR in classifying dependence with F1-scores of 0.603 (95% CI; 0.594–0.611) and 0.577 (95% CI; 0.568–0.586), versus 0.544 (95% CI; 0.545–0.563) for the mLR model. The factors that contributed most to the predictions were expectedly similar in the models, based on clinical knowledge. Our ANN and XGBoost models showed a modest improvement in prediction performance and explainability compared to mLR using routinely-collected data. Their improved ability to predict functional dependence may be of particular importance for the planning and organization of acute stroke care and rehabilitation.

Suggested Citation

  • Josline Adhiambo Otieno & Jenny Häggström & David Darehed & Marie Eriksson, 2024. "Developing machine learning models to predict multi-class functional outcomes and death three months after stroke in Sweden," PLOS ONE, Public Library of Science, vol. 19(5), pages 1-16, May.
    • Handle: RePEc:plo:pone00:0303287
    DOI: 10.1371/journal.pone.0303287
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    References listed on IDEAS

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    1. repec:plo:pmed00:0040296 is not listed on IDEAS
    2. Hamed Asadi & Richard Dowling & Bernard Yan & Peter Mitchell, 2014. "Machine Learning for Outcome Prediction of Acute Ischemic Stroke Post Intra-Arterial Therapy," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-11, February.
    3. Agni Orfanoudaki & Emma Chesley & Christian Cadisch & Barry Stein & Amre Nouh & Mark J Alberts & Dimitris Bertsimas, 2020. "Machine learning provides evidence that stroke risk is not linear: The non-linear Framingham stroke risk score," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-20, May.
    4. Wenjuan Wang & Martin Kiik & Niels Peek & Vasa Curcin & Iain J Marshall & Anthony G Rudd & Yanzhong Wang & Abdel Douiri & Charles D Wolfe & Benjamin Bray, 2020. "A systematic review of machine learning models for predicting outcomes of stroke with structured data," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-16, June.
    5. Esra Zihni & Vince Istvan Madai & Michelle Livne & Ivana Galinovic & Ahmed A Khalil & Jochen B Fiebach & Dietmar Frey, 2020. "Opening the black box of artificial intelligence for clinical decision support: A study predicting stroke outcome," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-15, April.
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