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Developing machine learning models to predict multi-class functional outcomes and death three months after stroke in Sweden
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0009-0006-1030-4237
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0002-9086-7403
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-5917-0384
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0003-3298-1555
2024 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 5, article id e0303287Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2024. Vol. 19, no 5, article id e0303287
National Category
Probability Theory and Statistics Cardiology and Cardiovascular Disease
Research subject
Statistics
Identifiers
URN: urn:nbn:se:umu:diva-224459DOI: 10.1371/journal.pone.0303287ISI: 001245059300043PubMedID: 38739586Scopus ID: 2-s2.0-85192913786OAI: oai:DiVA.org:umu-224459DiVA, id: diva2:1858586
Available from: 2024-05-17 Created: 2024-05-17 Last updated: 2025-04-24Bibliographically approved

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Otieno, Josline AdhiamboHäggström, JennyDarehed, DavidEriksson, Marie

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