PT - JOURNAL ARTICLE AU - Jessica Quah AU - Charlene Jin Yee Liew AU - Lin Zou AU - Xuan Han Koh AU - Rayan Alsuwaigh AU - Venkataraman Narayan AU - Tian Yi Lu AU - Clarence Ngoh AU - Zhiyu Wang AU - Juan Zhen Koh AU - Christine Ang AU - Zhiyan Fu AU - Han Leong Goh TI - Chest radiograph-based artificial intelligence predictive model for mortality in community-acquired pneumonia AID - 10.1136/bmjresp-2021-001045 DP - 2021 Aug 01 TA - BMJ Open Respiratory Research PG - e001045 VI - 8 IP - 1 4099 - http://bmjopenrespres.bmj.com/content/8/1/e001045.short 4100 - http://bmjopenrespres.bmj.com/content/8/1/e001045.full SO - BMJ Open Resp Res2021 Aug 01; 8 AB - Background Chest radiograph (CXR) is a basic diagnostic test in community-acquired pneumonia (CAP) with prognostic value. We developed a CXR-based artificial intelligence (AI) model (CAP AI predictive Engine: CAPE) and prospectively evaluated its discrimination for 30-day mortality.Methods Deep-learning model using convolutional neural network (CNN) was trained with a retrospective cohort of 2235 CXRs from 1966 unique adult patients admitted for CAP from 1 January 2019 to 31 December 2019. A single-centre prospective cohort between 11 May 2020 and 15 June 2020 was analysed for model performance. CAPE mortality risk score based on CNN analysis of the first CXR performed for CAP was used to determine the area under the receiver operating characteristic curve (AUC) for 30-day mortality.Results 315 inpatient episodes for CAP occurred, with 30-day mortality of 19.4% (n=61/315). Non-survivors were older than survivors (mean (SD)age, 80.4 (10.3) vs 69.2 (18.7)); more likely to have dementia (n=27/61 vs n=58/254) and malignancies (n=16/61 vs n=18/254); demonstrate higher serum C reactive protein (mean (SD), 109 mg/L (98.6) vs 59.3 mg/L (69.7)) and serum procalcitonin (mean (SD), 11.3 (27.8) μg/L vs 1.4 (5.9) μg/L). The AUC for CAPE mortality risk score for 30-day mortality was 0.79 (95% CI 0.73 to 0.85, p<0.001); Pneumonia Severity Index (PSI) 0.80 (95% CI 0.74 to 0.86, p<0.001); Confusion of new onset, blood Urea nitrogen, Respiratory rate, Blood pressure, 65 (CURB-65) score 0.76 (95% CI 0.70 to 0.81, p<0.001), respectively. CAPE combined with CURB-65 model has an AUC of 0.83 (95% CI 0.77 to 0.88, p<0.001). The best performing model was CAPE incorporated with PSI, with an AUC of 0.84 (95% CI 0.79 to 0.89, p<0.001).Conclusion CXR-based CAPE mortality risk score was comparable to traditional pneumonia severity scores and improved its discrimination when combined.Data are available on reasonable request. Deidentified data are available from the corresponding author on reasonable request subjected to institutional approval.