RT Journal Article
SR Electronic
T1 Chest radiograph-based artificial intelligence predictive model for mortality in community-acquired pneumonia
JF BMJ Open Respiratory Research
JO BMJ Open Resp Res
FD British Thoracic Society
SP e001045
DO 10.1136/bmjresp-2021-001045
VO 8
IS 1
A1 Jessica Quah
A1 Charlene Jin Yee Liew
A1 Lin Zou
A1 Xuan Han Koh
A1 Rayan Alsuwaigh
A1 Venkataraman Narayan
A1 Tian Yi Lu
A1 Clarence Ngoh
A1 Zhiyu Wang
A1 Juan Zhen Koh
A1 Christine Ang
A1 Zhiyan Fu
A1 Han Leong Goh
YR 2021
UL http://bmjopenrespres.bmj.com/content/8/1/e001045.abstract
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.