Predicting ICU Readmission in Acute Pancreatitis Patients Using a Machine Learning-Based Model with Enhanced Clinical Interpretability

Abstract

Acute pancreatitis (AP) is a common and potentially life-threatening gastrointestinal disease that imposes a significant burden on healthcare systems. ICU readmissions among AP patients are common, especially in severe cases, with rates exceeding 40%. Identifying high-risk patients for readmission is crucial for improving outcomes. This study used the MIMIC-III database to identify ICU admissions for AP based on diagnostic codes. We applied a preprocessing pipeline including missing data imputation, correlation analysis, and hybrid feature selection. Recursive Feature Elimination with Cross-Validation (RFECV) and LASSO regression, supported by expert review, reduced over 50 variables to 20 key predictors, covering demographics, comorbidities, lab tests, and interventions. To address class imbalance, we used the Synthetic Minority Over-sampling Technique (SMOTE) in a five-fold cross-validation framework. We developed and optimized six machine learning models-Logistic Regression, k-Nearest Neighbors, Naive Bayes, Random Forest, LightGBM, and XGBoost-using grid search. Model performance was evaluated with AUROC, accuracy, F1 score, sensitivity, specificity, PPV, and NPV. XGBoost performed best, with an AUROC of 0.862 (95% CI: 0.800-0.920) and accuracy of 0.889 (95% CI: 0.858-0.923) on the test set. An ablation study showed that removing any feature decreased performance. SHAP analysis identified platelet count, age, and SpO2 as key predictors of readmission. This study shows that ensemble learning, informed feature selection, and handling class imbalance can improve ICU readmission prediction in AP patients, supporting targeted post-discharge interventions.