- Article
Development and Validation of a CatBoost-Based Model for Predicting Significant Creatinine Elevation in ICU Patients Receiving Vancomycin Therapy
- Junyi Fan,
- Li Sun and
- Shuheng Chen
- + 3 authors
Vancomycin remains a cornerstone for severe Gram-positive infections in the ICU, yet creatinine elevation—a sensitive marker of early renal stress—occurs frequently and complicates therapy. We developed a machine learning model to predict vancomycin-associated creatinine elevation using routinely available clinical data, enabling preemptive risk stratification. In this retrospective MIMIC-IV cohort study (
ICU adults aged 18–80 receiving vancomycin), the primary outcome was creatinine elevation per KDIGO criteria (≥0.3 mg/dL within 48 h or ≥50% within 7 d). A two-stage feature selection (SelectKBest + Random Forest) identified 15 predictors from 30 candidates. Six algorithms were compared via 5-fold cross-validation. CatBoost was selected for final modeling; interpretability was assessed using SHAP values and Accumulated Local Effects (ALE) plots. Creatinine elevation occurred in 2903 patients (28.2%). CatBoost achieved AUROC 0.818 (95% CI: 0.801–0.834), sensitivity 0.800, specificity 0.681, and NPV 0.900. Top predictors were serum phosphate, total bilirubin, magnesium, Charlson Comorbidity Index, and APSIII score. SHAP analysis confirmed hyperphosphatemia as the strongest driver; ALE plots revealed non-linear, clinically plausible thresholds (e.g., phosphate >4.5 mg/dL sharply increased risk). This interpretable model accurately predicts vancomycin-associated creatinine elevation using standard ICU monitoring data. With high negative predictive value, it supports early exclusion of low-risk patients and targeted interventions (e.g., intensified TDM, nephrotoxin avoidance) in high-risk cases—facilitating precision antimicrobial stewardship in critical care.
10 December 2025




