{
  "abstract": "Background\n\nIn-hospital cardiac arrest (IHCA) is a rare but life-threatening complication in elderly surgical patients. This study aimed to develop and validate a machine learning model for predicting IHCA and to identify key perioperative risk factors.Methods\n\nA multicenter retrospective cohort study was conducted among patients aged ≥65 years who underwent non-cardiac surgery at six tertiary hospitals between January 2020 and January 2025. Clinical, laboratory, and perioperative variables were collected. Five machine learning algorithms, including Extreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Multilayer Perceptron (MLP), and K-Nearest Neighbor (KNN), were developed and compared. Model performance was evaluated using receiver operating characteristic (ROC) analysis, calibration, decision curve analysis, cross-validation, and external validation. SHAP analysis was applied to interpret the optimal model.Results\n\nAmong the five models, XGBoost demonstrated the best predictive performance, with AUCs of 0.967 and 0.960 in the training and validation cohorts, respectively. It also achieved the lowest Brier score and the highest clinical net benefit. External validation confirmed excellent discrimination (AUC=0.971) and calibration. SHAP analysis identified advanced age, intraoperative tachycardia, intraoperative hypotension, intraoperative blood transfusion, intraoperative hypoxemia, elevated postoperative neutrophil-to-lymphocyte ratio, B-type natriuretic peptide, lactate, and D-dimer levels as the most important predictors of IHCA.Conclusion\n\nAn interpretable XGBoost-based model demonstrated excellent performance for predicting postoperative cardiac arrest in elderly patients. The identified risk factors reflected perioperative vulnerability, intraoperative hemodynamic instability, and postoperative physiological deterioration.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hepatobiliary Surgery, The Affiliated Yixing Hospital of Jiangsu University, Yixing, China.",
    "Yixing Branch of the Wuxi Medical Centre Affiliated to Nanjing Medical University, Yixing, China.",
    "Department of General Surgery, The Affiliated Tengzhou Central People's Hospital of Xuzhou Medical University, Zao Zhuang, China.",
    "Clinical Medical Center, Tengzhou Central People's Hospital, Tengzhou, Shandong, China.",
    "Gaomi People's Hospital, Gaomi, Shandong, China.",
    "Tengzhou Hospital of Traditional Chinese Medicine, Shandong, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Xi Chen"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yuwei Chang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Tao Sun"
    },
    {
      "affs": [
        0,
        2,
        3,
        4,
        5
      ],
      "name": "Yuan Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Lei Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Chao Jiang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Feng Zhan"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Wenyi Du"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3h0w5kehbc21c.bib",
  "cited_by": 0,
  "doi": "10.3389/fmed.2026.1922481",
  "fulltext_url": "https://europepmc.org/articles/PMC13710317",
  "id": "3h0w5kehbc21c",
  "issns": [
    "2296-858X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42948089",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Cardiac, Anesthesia and Surgical Outcomes"
    ]
  ],
  "openalex": "W7221706684",
  "pdf_url": "https://europepmc.org/articles/PMC13710317?pdf=render",
  "pmcid": "PMC13710317",
  "pmid": "42948089",
  "published": "2026-10-13",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/3h0w5kehbc21c.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42948089",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42948089"
    },
    {
      "first_seen": "2026-10-31T12:21:18Z",
      "native_id": "PMC13710317",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fmed.2026.1922481"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac, Anesthesia and Surgical Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Development and multicenter validation of a machine learning model for predicting in-hospital postoperative cardiac arrest in elderly surgical patients: the critical role of intraoperative hemodynamic disturbances and blood transfusion.",
  "title_text": "Development and multicenter validation of a machine learning model for predicting in-hospital postoperative cardiac arrest in elderly surgical patients: the critical role of intraoperative hemodynamic disturbances and blood transfusion.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:18Z",
  "url": "https://research.draconitic.com/paper/3h0w5kehbc21c",
  "venue": "Frontiers in medicine",
  "versions": []
}