Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 602-608. doi: 10.19723/j.issn.1671-167X.2019.03.034

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Application of recurrent neural network in prognosis of peritoneal dialysis

Wen TANG1△(),Jun-yi GAO2,Xin-yu MA2,3,Chao-he ZHANG2,Lian-tao MA2,3,Ya-sha WANG2,4△()   

  • Received:2019-03-18 Online:2019-05-22 Published:2019-06-26
  • Supported by:
    Supported by the Fundamental Research Funds for the Central Universities: Peking University Medicine Seed Fund for Interdisciplinary Research (BMU20160584)

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Abstract: Objective: Deep learning models, including recurrent neural network (RNN) and gated recurrent unit (GRU), were used to construct the clinical prognostic prediction models for peritoneal dialysis (PD) patients based on routine clinical data. The performance of the RNN and GRU were compared with logistic regression (LR), which is commonly used in medical researches. The possible underlining clinical implications based on the result from the GRU model were also investigated.Methods: We used the clinical data from the PD center of Peking University Third Hospital as the data source. Both the baseline data at the beginning of dialysis, and the follow-up and prognostic data of the patients were used by the RNN and GRU prediction models. The hyper-parameters were tuned based on the 10-fold cross-validation. The risk prediction performance of each model was evaluated via area under the receiver ope-ration characteristic curve (AUROC), recall rate and F1-score on the testset. Results: A total of 656 patients with the 261 occurrences of death were included in the experiment. The total number of all diagnostic records were 13 091. The results on the testset showed that the AUROC of the LR model, RNN mo-del, and GRU model was 0.701 4, 0.786 0, and 0.814 7, respectively. The predictive performances of the GRU and RNN models were significantly better than that of the LR model. The performances of the GRU and RNN models assessed by recall rate and F1-score were also significantly better than that of the LR model, in which the GRU model reached the best performance. In addition, the recall rates were different among different causes of death or by different prediction time windows.Conclusion: The recurrent neural network model, especially the GRU model, is more effective in predicting PD patients’ prognosis as compared with the LR model. This new model may be helpful for clinicians to provide timely intervention, thus improving the quality of care of PD.

Key words: Peritoneal dialysis, Prognosis, Mortality risk prediction, Recurrent neural network, Gated recurrent unit

CLC Number: 

  • R459.51

Table 1

Clinical features of peritoneal dialysis"

Categories of Features
Dynamic features
Blood test
Blood routine: WBC counts, Hb
ALB
Renal function: urea, Cr, uric acid
Electrolyte: K, Na, Cl, CO2CP
Others: Glu, hs-CRP, Ca, P, iPTH
Complications: peritonitis, catheter-related infections, other infections, cardiovascular disease, diabetic foot, cerebrovascular disease, cancer,
hernia, fracture, upper respiratory tract infection, other complications
Nutrition & physical tests: weight, systolic pressure, diastolic pressure
Static baseline features
Demographic features: age, gender
Underlying diseases: baseline comorbidities
Physical tests: height

Figure 1

Definition of health risk labels"

Figure 2

Recurrent neural network"

Table 2

Statistics of peritoneal dialysis clinical features in the dataset"

Feature Mean Std Median
Cl/(mmol/L) 98.01 4.84 98.00
CO2CP 27.39 3.64 27.40
Blood uric acid/(mmol/L) 391.61 148.41 380.00
WBC counts/(×109/L) 8.30 55.51 7.49
Hb/(g/L) 114.77 16.83 115.00
Urea/(mmol/L) 19.96 5.46 19.60
Ca/(mmol/L) 2.40 0.37 2.38
K/(mmol/L) 4.32 0.72 4.24
Na/(mmol/L) 138.54 3.88 139.00
Cr/(μmol/L) 857.34 283.70 839.00
P/(mmol/L) 1.60 0.43 1.56
ALB/(g/L) 37.65 4.44 37.90
iPTH/(pg/mL) 214.63 237.93 141.60
hs-CRP/(mg/L) 8.68 15.92 3.34
Glu/(mmol/L) 6.67 3.05 5.70

Table 3

Statistics of peritoneal dialysis complications in the dataset"

Disease Percentage of diagnosed patients
Peritonitis 60.82%
Upper respiratory tract infection 26.98%
Catheter-related infections 9.76%
Other infections 22.10%
Cardiovascular disease 11.74%
Cerebrovascular disease 2.59%
Diabetic foot 3.05%
Cancer 4.12%
Hernia 2.13%
Fracture 1.37%
Other complications 19.21%

Figure 3

Gated recurrent unit, which is used to perform classification based on time series data"

Table 4

Statistics information of patients"

Statistics Mean Median Maximum Minimum Std
Age of the patients 58.55 60.70 97.45 16.79 15.81
Number of visits 19.95 16 69 1 13.53
Number of visits that are one year before the death 2 0 29 0 2.95

Figure 4

Data distribution of age and visiting frequency in the dataset"

Table 5

Average performance of each prediction model in testset"

Metric LR RNN GRU
AUROC 70.14% 78.60% 81.47%
F1-score 79.32% 86.84% 88.01%
Recall 26.13% 39.42% 48.19%

Figure 5

ROC of prediction models AUROC, area under the receiver operation characteristic curve."

Figure 6

Recall of different death reasons at different prediction windows PDAP, peritoneal dialysis associated peritonitis; PVD, peripheral vascular disease; GI, gastrointestinal."

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