Machine Learning Prediction Models for Postoperative Stroke in Elderly Patients: Analyses of the MIMIC Database

Objective: With the aging of populations and the high prevalence of stroke, postoperative stroke has become a growing concern. This study aimed to establish a prediction model and assess the risk factors for stroke in elderly patients during the postoperative period.

Methods: ML (Machine learning) prediction models were applied to elderly patients from the MIMIC (Medical Information Mart for Intensive Care)-III and MIMIC-VI databases. The SMOTENC (synthetic minority oversampling technique for nominal and continuous data) balancing technique and iterative SVD (Singular Value Decomposition) data imputation method were used to address the problem of category imbalance and missing values, respectively. We analyzed the possible predictive factors of stroke in elderly patients using seven modeling approaches to train the model. The diagnostic value of the model derived from machine learning was evaluated by the ROC curve (receiver operating characteristic curve).

Results: We analyzed 7,128 and 661 patients from MIMIC-VI and MIMIC-III, respectively. The XGB (extreme gradient boosting) model got the highest AUC (area under the curve) of 0.78 (0.75-0.81), making it better than the other six models, Besides, we found that XGB model with databalancing was better than that without data balancing. Based on this prediction model, we found hypertension, cancer, congestive heart failure, chronic pulmonary disease and peripheral vascular disease were the top five predictors. Furthermore, we demonstrated that hypertension predicted postoperative stroke is much more valuable.

Conclusion: Stroke in elderly patients during the postoperative period can be reliably predicted. We proved XGB model is a reliable predictive model, and the history of hypertension should be weighted more heavily than the results of laboratory tests to prevent postoperative stroke in elderly patients regardless of gender.