Machine Learning-Based Scoring Model for Predicting Mortality in ICU-Admitted Ischemic Stroke Patients with Moderate to Severe Consciousness Disorders

Zhou Zhou ¹ Bo Chen ² Zhao-Jun Mei ¹ Wei Chen ¹ Wei Cao ³ En-Xi Xu ² Jun Wang ² Lei Ye ^1* Hongwei Cheng ^1*

• ¹ Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
• ² Department of Neurosurgery, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu Province, China
• ³ Department of Neurology, Zhenjiang First People's Hospital, zhenjiang, China

Background Stroke is a leading cause of mortality and disability globally. Among ischemic stroke patients, those with moderate to severe consciousness disorders constitute a particularly high-risk subgroup. Accurate predictive models are essential for guiding clinical decisions in this population.This study aimed to develop and validate an automated scoring system using machine learning algorithms for predicting short-term (3-and 7-day) and relatively long-term (30-and 90-day) mortality in this population.Methods This retrospective observational study utilized data from the MIMIC-IV database, including 648 ischemic stroke patients with Glasgow Coma Scale (GCS) scores ≤12, admitted to the ICU between 2008 and 2019. Patients with GCS scores indicating speech dysfunction but clear consciousness were excluded. A total of 47 candidate variables were evaluated, and the top six predictors for each mortality model were identified using the AutoScore framework. Model performance was assessed using the area under the curve (AUC) from receiver operating characteristic (ROC) analyses.The median age of the cohort was 76.8 years (IQR, 64.97-86.34), with mortality rates of 8.02% at 3 days, 18.67% at 7 days, 33.49% at 30 days, and 38.89% at 90 days. The AUCs for the test cohort's 3-, 7-, 30-, and 90-day mortality prediction models were 0.698, 0.678, 0.724, and 0.730, respectively.We developed and validated a novel machine learning-based scoring tool that effectively predicts both short-term and relatively long-term mortality in ischemic stroke patients with moderate to severe consciousness disorders. This tool has the potential to enhance clinical decision-making and resource allocation for these patients in the ICU.