Explainable Mortality Prediction Model for Congestive Heart Failure with Nature-Based Feature Selection Method
Authors: Tasnim Nusrat , Al Mamun Shamim Al , Shahidul Islam Mohammad Shahidul , Kaiser M. Shamim , Mahmud Mufti 
Published: May 2023

A mortality prediction model can be a great tool to assist physicians in decision making in the intensive care unit (ICU) in order to ensure optimal allocation of ICU resources according to the patient’s health conditions. The entire world witnessed a severe ICU patient capacity crisis a few years ago during the COVID-19 pandemic. Various widely utilized machine learning (ML) models in this research field can provide poor performance due to a lack of proper feature selection. Despite the fact that nature-based algorithms in other sectors perform well for feature selection, no comparative study on the performance of nature-based algorithms in feature selection has been conducted in the ICU mortality prediction field. Therefore, in this research, a comparison of the performance of ML models with and without feature selection was performed. In addition, explainable artificial intelligence (AI) was used to examine the contribution of features to the decision-making process. Explainable AI focuses on establishing transparency and traceability for statistical black-box machine learning techniques. Explainable AI is essential in the medical industry to foster public confidence and trust in machine learning model predictions. Three nature-based algorithms, namely the flower pollination algorithm (FPA), particle swarm algorithm (PSO), and genetic algorithm (GA), were used in this study. For the classification job, the most widely used and diversified classifiers from the literature were used, including logistic regression (LR), decision tree (DT) classifier, the gradient boosting (GB) algorithm, and the random forest (RF) algorithm. The Medical Information Mart for Intensive Care III (MIMIC-III) dataset was used to collect data on heart failure patients. On the MIMIC-III dataset, it was discovered that feature selection significantly improved the performance of the described ML models. Without applying any feature selection process on the MIMIC-III heart failure patient dataset, the accuracy of the four mentioned ML models, namely LR, DT, RF, and GB was 69.9%, 82.5%, 90.6%, and 91.0%, respectively, whereas with feature selection in combination with the FPA, the accuracy increased to 71.6%, 84.8%, 92.8%, and 91.1%, respectively, for the same dataset. Again, the FPA showed the highest area under the receiver operating characteristic (AUROC) value of 83.0% with the RF algorithm among all other algorithms utilized in this study. Thus, it can be concluded that the use of feature selection with FPA has a profound impact on the outcome of ML models. Shapley additive explanation (SHAP) was used in this study to interpret the ML models. SHAP was used in this study because it offers mathematical assurances for the precision and consistency of explanations. It is trustworthy and suitable for both local and global explanations. It was found that the features that were selected by SHAP as most important were also most common with the features selected by the FPA. Therefore, we hope that this study will help physicians to predict ICU mortality for heart failure patients with a limited number of features and with high accuracy.