Real-time prediction of HFNC treatment failure in acute hypoxemic respiratory failure using machine learning

Accurate and timely prediction of high-flow nasal cannula (HFNC) treatment failure in patients with acute hypoxemic respiratory failure (AHRF) can lower patient mortality. Previous studies have highlighted inconsistencies in the predictive performance of existing indices, such as ROX and mROX, which are limited by their reliance on oxygenation parameters alone. To address this, we developed a machine learning-based predictive model using temporal data from AHRF patients, aimed at facilitating quicker development of individualized treatment plans and intervention strategies for healthcare professionals. We extracted 15 non-invasive and 15 laboratory features, including patient demographic characteristics, Glasgow Coma Scale, blood gas analysis, chemical assay, and complete blood cell count features. In addition to five machine learning models and an ensemble classifier, an long short-term memory (LSTM) network was included to assess deep learning performance on time-series data. Our study enrolled 427 patients with 498 treatment records. The soft-voting ensemble algorithm achieved an optimal predictive performance with an AUC of 0.839 (95% CI 0.786-0.889) for the all-features model, while logistic regression using common features achieved an AUC of 0.767 (95% CI 0.704-0.825), outperforming ROX and mROX indices. Incorporating blood gas analysis features improved the non-invasive model's performance by 0.104. This study introduces a machine learning model integrated with a dynamic real-time alert system for predicting HFNC treatment failure in AHRF patients, demonstrating improved performance over traditional indices in internal validation and showing potential for decision support in select healthcare settings.