Development and external validation of an interpretable machine learning model for the prediction of intubation in the intensive care unit

Given the limited capacity to accurately determine the necessity for intubation in intensive care unit settings, this study aimed to develop and externally validate an interpretable machine learning model capable of predicting the need for intubation among ICU patients. Seven widely used machine learning (ML) algorithms were employed to construct the prediction models. Adult patients from the Medical Information Mart for Intensive Care IV database who stayed in the ICU for longer than 24 h were included in the development and internal validation. The model was subsequently externally validated using the eICU-CRD database. In addition, the SHapley Additive exPlanations method was employed to interpret the influence of individual parameters on the predictions made by the model. A total of 11,988 patients were included in the final cohort for this study. The CatBoost model demonstrated the best performance (AUC: 0.881). In the external validation set, the efficacy of our model was also confirmed (AUC: 0.750), which suggests robust generalization capabilities. The Glasgow Coma Scale (GCS), body mass index (BMI), arterial partial pressure of oxygen (PaO₂), respiratory rate (RR) and length of stay (LOS) before ICU were the top 5 features of the CatBoost model with the greatest impact. We developed an externally validated CatBoost model that accurately predicts the need for intubation in ICU patients within 24 to 96 h of admission, facilitating clinical decision-making and has the potential to improve patient outcomes. The prediction model utilizes readily obtainable monitoring parameters and integrates the SHAP method to enhance interpretability, providing clinicians with clear insights into the factors influencing predictions.