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1. INFORMING INTENSIVE CARE UNIT DIGITAL TWINS: DYNAMIC ASSESSMENT OF CARDIORESPIRATORY FAILURE TRAJECTORIES IN PATIENTS WITH SEPSIS

   https://doi.org/10.1097/SHK.0000000000002536  

   Hou, Grace Yao; Lal, Amos; Schulte, Phillip J; Dong, Yue; Kilickaya, Oguz; Gajic, Ognjen; Zhong, Xiang (January 2025, Shock)

   ABSTRACT Understanding clinical trajectories of sepsis patients is crucial for prognostication, resource planning, and to inform digital twin models of critical illness. This study aims to identify common clinical trajectories based on dynamic assessment of cardiorespiratory support using a validated electronic health record data that covers retrospective cohort of 19,177 patients with sepsis admitted to intensive care units (ICUs) of Mayo Clinic Hospitals over 8-year period. Patient trajectories were modeled from ICU admission up to 14 days using an unsupervised machine learning two-stage clustering method based on cardiorespiratory support in ICU and hospital discharge status. Of 19,177 patients, 42% were female with a median age of 65 (interquartile range [IQR], 55–76) years, The Acute Physiology, Age, and Chronic Health Evaluation III score of 70 (IQR, 56–87), hospital length of stay (LOS) of 7 (IQR, 4–12) days, and ICU LOS of 2 (IQR, 1–4) days. Four distinct trajectories were identified: fast recovery (27% with a mortality rate of 3.5% and median hospital LOS of 3 (IQR, 2–15) days), slow recovery (62% with a mortality rate of 3.6% and hospital LOS of 8 (IQR, 6–13) days), fast decline (4% with a mortality rate of 99.7% and hospital LOS of 1 (IQR, 0–1) day), and delayed decline (7% with a mortality rate of 97.9% and hospital LOS of 5 (IQR, 3–8) days). Distinct trajectories remained robust and were distinguished by Charlson Comorbidity Index, The Acute Physiology, Age, and Chronic Health Evaluation III scores, as well as day 1 and day 3 SOFA (P< 0.001 ANOVA). These findings provide a foundation for developing prediction models and digital twin decision support tools, improving both shared decision making and resource planning. 

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2. A Feature Selection Method Based on Shapley Value to False Alarm Reduction in ICUs A Genetic-Algorithm Approach

   https://doi.org/10.1109/EMBC.2018.8512266  

   Zaeri-Amirani, Mohammad; Afghah, Fatemeh; Mousavi, Sajad (July 2018, A Feature Selection Method Based on Shapley Value to False Alarm Reduction in ICUs A Genetic-Algorithm Approach)

   High false alarm rate in intensive care units (ICUs) has been identified as one of the most critical medical challenges in recent years. This often results in overwhelming the clinical staff by numerous false or unurgent alarms and decreasing the quality of care through enhancing the probability of missing true alarms as well as causing delirium, stress, sleep deprivation and depressed immune systems for patients. One major cause of false alarms in clinical practice is that the collected signals from different devices are processed individually to trigger an alarm, while there exists a considerable chance that the signal collected from one device is corrupted by noise or motion artifacts. In this paper, we propose a low-computational complexity yet accurate game-theoretic feature selection method which is based on a genetic algorithm that identifies the most informative biomarkers across the signals collected from various monitoring devices and can considerably reduce the rate of false alarms. 

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3. Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN

   Banerjee R.; Komarow L.; Virk A.; Rajapakse N.; Schuetz A.; Dylla B.; Earley M.; Lok J.J.; Kohner P.; Ihde S.; et al (July 2021, Clinical infectious diseases)

   Background. Rapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). Methods. Patients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. Results. Of 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P < .001) and AST (13.5 [56] vs 44.9 [12.1] hours; P < .001). Median (interquartile range [IQR]) time to first antibiotic modification was faster in the RAPID arm vs the SOC arm for overall antibiotics (8.6 [2.6–27.6] vs 14.9 [3.3–41.1] hours; P = .02) and gram-negative antibiotics (17.3 [4.9–72] vs 42.1 [10.1–72] hours; P < .001). Median (IQR) time to antibiotic escalation was faster in the RAPID arm vs the SOC arm for antimicrobial-resistant BSIs (18.4 [5.8–72] vs 61.7 [30.4–72] hours; P = .01). There were no differences between the arms in patient outcomes. Conclusions. Rapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. 

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4. Trial-By-Trial Variation In Upper Extremity Movement Smoothness After Acute Stroke Relates To Clinical Assessments And Corticospinal Tract Injury

   https://doi.org/10.1177/15459683251340916  

   Cavanagh, Sarah K; Gochyyev, Perman; Nayeem, Rashida; Dusang, Aliceson N; Hamilton, Taya; DiCarlo, Julie A; Kautz, Steven A; Sternad, Dagmar; Walsh, Conor; Hochberg, Leigh; et al (August 2025, Neurorehabilitation and Neural Repair)

   BackgroundVariability in movement is critical for performance under dynamic conditions. Stroke causes focal injury to the motor system, disrupts voluntary motor control, and leads to less smooth and more variable upper extremity movements. Few studies have characterized trial-by-trial variation in upper extremity movement smoothness and its clinical and neuroanatomic correlates in the first week post-stroke. ObjectiveTo evaluate trial-by-trial variation in upper extremity movement smoothness during planar reaching and relate it to clinical outcomes and neuroanatomical injury after acute stroke. MethodsTwenty-two patients (4.4 ± 1.7 days post-stroke) and 22 able-bodied adults completed a planar center-out reaching task. Smoothness was quantified with spectral arc length (SPARC). Median and interquartile range (IQR, a quantification of trial-by-trial variation) of SPARC values were assessed. Patients completed a clinical assessment battery acutely and at 90 days post-stroke. MRI-derived stroke lesions were analyzed to estimate basal ganglia, motor cortex, and corticospinal tract injury. Intraclass correlation, Spearman’s correlation, and multivariate regression evaluated trial-by-trial variation and its relation to clinical assessments, outcomes, and neuroanatomical injury. ResultsPost-stroke reaching was less smooth and more variable (larger IQR) compared to able-bodied adults. Variability in post-stroke smoothness was primarily driven by within-subject, trial-by-trial variation. More variable smoothness, even after controlling for median smoothness, related to worse performance on clinical assessments and 90-day outcomes. More variable smoothness related to greater corticospinal tract injury (ρ = 0.537,P = .011), but not to basal ganglia or motor cortex injury. ConclusionTrial-by-trial variation of movement is valuable for understanding sensorimotor control post-stroke and has implications for targeted neurorehabilitation. 

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5. Interictal EEG and ECG for SUDEP Risk Assessment: A Retrospective Multicenter Cohort Study

   https://doi.org/10.3389/fneur.2022.858333  

   Chen, Zhe Sage; Hsieh, Aaron; Sun, Guanghao; Bergey, Gregory K.; Berkovic, Samuel F.; Perucca, Piero; D'Souza, Wendyl; Elder, Christopher J.; Farooque, Pue; Johnson, Emily L.; et al (March 2022, Frontiers in Neurology)

   Objective Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality. Although lots of effort has been made in identifying clinical risk factors for SUDEP in the literature, there are few validated methods to predict individual SUDEP risk. Prolonged postictal EEG suppression (PGES) is a potential SUDEP biomarker, but its occurrence is infrequent and requires epilepsy monitoring unit admission. We use machine learning methods to examine SUDEP risk using interictal EEG and ECG recordings from SUDEP cases and matched living epilepsy controls. Methods This multicenter, retrospective, cohort study examined interictal EEG and ECG recordings from 30 SUDEP cases and 58 age-matched living epilepsy patient controls. We trained machine learning models with interictal EEG and ECG features to predict the retrospective SUDEP risk for each patient. We assessed cross-validated classification accuracy and the area under the receiver operating characteristic (AUC) curve. Results The logistic regression (LR) classifier produced the overall best performance, outperforming the support vector machine (SVM), random forest (RF), and convolutional neural network (CNN). Among the 30 patients with SUDEP [14 females; mean age (SD), 31 (8.47) years] and 58 living epilepsy controls [26 females (43%); mean age (SD) 31 (8.5) years], the LR model achieved the median AUC of 0.77 [interquartile range (IQR), 0.73–0.80] in five-fold cross-validation using interictal alpha and low gamma power ratio of the EEG and heart rate variability (HRV) features extracted from the ECG. The LR model achieved the mean AUC of 0.79 in leave-one-center-out prediction. Conclusions Our results support that machine learning-driven models may quantify SUDEP risk for epilepsy patients, future refinements in our model may help predict individualized SUDEP risk and help clinicians correlate predictive scores with the clinical data. Low-cost and noninvasive interictal biomarkers of SUDEP risk may help clinicians to identify high-risk patients and initiate preventive strategies. 

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