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Design of one-year mortality forecast at hospital admission based: a machine learning approach

Background: Palliative care is referred to a set of programs for patients that suffer life-limiting illnesses. These programs aim to guarantee a minimum level of quality of life (QoL) for the last stage of life. They are currently based on clinical evaluation of risk of one-year mortality. Objectives: The main objective of this work is to develop and validate machine-learning based models to predict the exitus of a patient within the next year using data gathered at hospital admission. Methods: Five machine learning techniques were applied in our study to develop machine-learning predictive models: Support Vector Machines, K-neighbors Classifier, Gradient Boosting Classifier, Random Forest and Multilayer Perceptron. All models were trained and evaluated using the retrospective dataset. The evaluation was performed with five metrics computed by a resampling strategy: Accuracy, the area under the ROC curve, Specificity, Sensitivity, and the Balanced Error Rate. Results: All models for forecasting one-year mortality achieved an AUC ROC from 0.858 to 0.911. Specifically, Gradient Boosting Classifier was the best model, producing an AUC ROC of 0.911 (CI 95%, 0.911 to 0.912), a sensitivity of 0.858 (CI 95%, 0.856 to 0.86) and a specificity of 0.807 (CI 95%, 0.806 to 0808) and a BER of 0.168 (CI 95%, 0.167 to 0.169). Conclusions: The analysis of common information at hospital admission combined with machine learning techniques produced models with competitive discriminative power. Our models reach the best results reported in state of the art. These results demonstrate that they can be used as an accurate data-driven palliative care criteria inclusion.