ArticleBioData mining2025
Subphenotype heterogeneity to guide predictive enrichment in acute kidney injury: insights from machine learning and target trial emulation.
Article in BioData mining, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Machine learning phenotypes and heterogeneous albumin effects in cirrhotic AKI: a causal inference study.Internal and emergency medicine · 2026Article
- FIRST-ICU: forecasting interventions and risk stratification in the ICU using graph neural network autoencoders.NPJ digital medicine · 2026Article
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Authors and funding
3 authors.
Funding
Abstract
backgroundAcute kidney injury (AKI) exhibits substantial heterogeneity in clinical presentation. Previous studies used traditional clustering approaches to identify subphenotypes, often focusing on adverse clinical outcomes, while ignoring that the central goal of subphenotyping is to enable individualized care.
objectiveIn this study, we aimed to identify distinct AKI subphenotypes and evaluate their heterogeneous associations with vasopressor choice and renal replacement therapy (RRT) strategies.
methodsThis retrospective cohort study used data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and included 31,030 patients diagnosed with AKI within 48 h of admission. Generative topographic mapping, a probabilistic unsupervised machine-learning model, was used to identify clusters. We then applied a target trial emulation framework to emulate comparisons of norepinephrine versus vasopressin, RRT modalities, and continuous RRT initiation timing across subphenotypes.
resultsFour distinct subphenotypes were identified, with marked differences in clinical features, laboratory abnormalities, and outcomes: a large group with intermediate severity; a hyper-inflammatory subphenotype with marked liver dysfunction and severe AKI; a cardiorenal congestion subphenotype with high cardiovascular comorbidity; and a younger subphenotype enriched for postoperative or trauma patients. Vasopressin was associated with reduced mortality in Subphenotype 2. A more delayed continuous RRT initiation strategy was linked to lower 60-day mortality in Subphenotypes 1 and 2. These associations remained robust in sensitivity analyses.
conclusionsWe identified four clinically distinct AKI subphenotypes that demonstrated substantial heterogeneity in their mortality associations with vasopressor use and RRT strategies. These findings could improve prognostication and advance precision medicine in critical care.
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