Abstract
BACKGROUND: Acute kidney injury is a common postoperative complication affecting between 10% and 30% of surgical patients. Acute kidney injury is associated with increased resource usage and chronic kidney disease development, with more severe acute kidney injury suggesting more aggressive deterioration in clinical outcomes and mortality. METHODS: We considered 42,906 surgical patients admitted to University of Florida Health (n = 51,806) between 2014 and 2021. Acute kidney injury stages were determined using the Kidney Disease Improving Global Outcomes serum creatinine criteria. We developed a recurrent neural network-based model to continuously predict acute kidney injury risk and state in the following 24 hours and compared it with logistic regression, random forest, and multi-layer perceptron models. We used medications, laboratory and vital measurements, and derived features from past one-year records as inputs. We analyzed the proposed model with integrated gradients for enhanced explainability. RESULTS: Postoperative acute kidney injury at any stage developed in 20% (10,664) of the cohort. The recurrent neural network model was more accurate in predicting nearly all categories of next-day acute kidney injury stages (including the no acute kidney injury group). The area under the receiver operating curve and 95% confidence intervals for recurrent neural network and logistic regression models were for no acute kidney injury (0.98 [0.98-0.98] vs 0.93 [0.93-0.93]), stage 1 (0.95 [0.95-0.95] vs. 0.81 [0.80-0.82]), stage 2/3 (0.99 [0.99-0.99] vs 0.96 [0.96-0.97]), and stage 3 with renal replacement therapy (1.0 [1.0-1.0] vs 1.0 [1.0-1.0]. CONCLUSION: The proposed model demonstrates that temporal processing of patient information can lead to more granular and dynamic modeling of acute kidney injury status and result in more continuous and accurate acute kidney injury prediction. We showcase the integrated gradients framework's utility as a mechanism for enhancing model explainability, potentially facilitating clinical trust for future implementation.