Integrating VAI-Assisted Quantified CXRs and Multimodal Data to Assess the Risk of Mortality.
Authors
Affiliations (9)
Affiliations (9)
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
- Department of Family and External Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
- Artificial Intelligence and Internet of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
- School of Medicine, National Defense Medical Center, Neihu Dist, No. 161, Min-Chun E. Rd., Sec. 6, Taipei, 114, Taiwan, ROC.
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
- Division of Cardiovascular Surgery, Cheng Hsin Rehabilitation and Medical Center, BeitouDist, No. 45, Zhenxing St, Taipei City, 112, Taiwan, ROC. [email protected].
- Artificial Intelligence and Internet of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. [email protected].
- School of Medicine, National Defense Medical Center, Neihu Dist, No. 161, Min-Chun E. Rd., Sec. 6, Taipei, 114, Taiwan, ROC. [email protected].
Abstract
To address the unmet need for a widely available examination for mortality prediction, this study developed a foundation visual artificial intelligence (VAI) to enhance mortality risk stratification using chest X-rays (CXRs). The VAI employed deep learning to extract CXR features and a Cox proportional hazard model to generate a hazard score ("CXR-risk"). We retrospectively collected CXRs from patients visited outpatient department and physical examination center. Subsequently, we reviewed mortality and morbidity outcomes from electronic medical records. The dataset consisted of 41,945, 10,492, 31,707, and 4441 patients in the training, validation, internal test, and external test sets, respectively. During the median follow-up of 3.2 (IQR, 1.2-6.1) years of both internal and external test sets, the "CXR-risk" demonstrated C-indexes of 0.859 (95% confidence interval (CI), 0.851-0.867) and 0.870 (95% CI, 0.844-0.896), respectively. Patients with high "CXR-risk," above 85th percentile, had a significantly higher risk of mortality than those with low risk, below 50th percentile. The addition of clinical and laboratory data and radiographic report further improved the predictive accuracy, resulting in C-indexes of 0.888 and 0.900. The VAI can provide accurate predictions of mortality and morbidity outcomes using just a single CXR, and it can complement other risk prediction indicators to assist physicians in assessing patient risk more effectively.