APRICOT-Mamba: Acuity Prediction in Intensive Care Unit (ICU): Development and Validation of a Stability, Transitions, and Life-Sustaining Therapies Prediction Model

The acuity state of patients in the intensive care unit (ICU) can quickly change from stable to unstable. Early detection of deteriorating conditions can result in providing timely interventions and improved survival rates. In this study, we propose APRICOT-M (Acuity Prediction in Intensive Care Unit-Mamba), a 150k-parameter state space-based neural network to predict acuity state, transitions, and the need for life-sustaining therapies in real-time in ICU patients. The model uses data obtained in the prior four hours in the ICU and patient information obtained at admission to predict the acuity outcomes in the next four hours. We validated APRICOT-M externally on data from hospitals not used in development (75,668 patients from 147 hospitals), temporally on data from a period not used in development (12,927 patients from one hospital from 2018-2019), and prospectively on data collected in real-time (215 patients from one hospital from 2021-2023) using three large datasets: the University of Florida Health (UFH) dataset, the electronic ICU Collaborative Research Database (eICU), and the Medical Information Mart for Intensive Care (MIMIC)-IV. The area under the receiver operating characteristic curve (AUROC) of APRICOT-M for mortality (external 0.94-0.95, temporal 0.97-0.98, prospective 0.96-1.00) and acuity (external 0.95-0.95, temporal 0.97-0.97, prospective 0.96-0.96) shows comparable results to state-of-the-art models. Furthermore, APRICOT-M can predict transitions to instability (external 0.81-0.82, temporal 0.77-0.78, prospective 0.68-0.75) and need for life-sustaining therapies, including mechanical ventilation (external 0.82-0.83, temporal 0.87-0.88, prospective 0.67-0.76), and vasopressors (external 0.81-0.82, temporal 0.73-0.75, prospective 0.66-0.74). This tool allows for real-time acuity monitoring in critically ill patients and can help clinicians make timely interventions.