Breaking New Ground: Machine Learning Enhances Survival Forecasts in Hypercapnic Respiratory Failure

Zhongxiang Liu ^1,2 Bingqing Zuo ^2* Jianyang Lin ^3* Zhixiao Sun ² Hang Hu ^2* Yuan Yin ^4* Shuanying Yang ^1*

• ¹ The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
• ² Yancheng First People's Hospital, Yancheng, China
• ³ Disease Prevention and Control Center of Funing County, Yancheng, China
• ⁴ First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China

Background: The prognostic prediction of patients with hypercapnic respiratory failure holds significant clinical value. The objective of this study was to develop and validate a predictive model for predicting survival in patients with hypercapnic respiratory failure. Methods: The study enrolled a total of 697 patients with hypercapnic respiratory failure, including 565 patients from the First People's Hospital of Yancheng in the modeling group and 132 patients from the People's Hospital of Jiangsu Province in the external validation group. The three selected models were Random Survival Forest (RSF), DeepSurv, a deep learning-based survival prediction algorithm, and Cox Proportional Risk (CoxPH). The model's predictive performance was evaluated using the C-index and Brier score. Receiver operating characteristic curve (ROC), area under ROC curve (AUC), and decision curve analysis (DCA) were employed to assess the accuracy of predicting the prognosis for survival at 6, 12, 18, and 24 months. Results: The RSF model (c-index: 0.792) demonstrated superior predictive ability for the prognosis of patients with hypercapnic respiratory failure compared to both the traditional CoxPH model (c-index: 0.699) and Deepsurv model (c-index: 0.618), which was further validated on external datasets. The Brier Score of the RSF model demonstrated superior performance, consistently measuring below 0.25 at the 6-month, 12-month, 18-month, and 24-month intervals. The ROC curve confirmed the superior discrimination of the RSF model, while DCA demonstrated its optimal clinical net benefit in both the modeling group and the external validation group. Conclusions: The RSF model offered distinct advantages over the CoxPH and DeepSurv models in terms of clinical evaluation and monitoring of patients with hypercapnic respiratory failure.