Classification of Blood Volume Decompensation State via Machine Learning Analysis of Multi-Modal Wearable-Compatible Physiological Signals.

This paper presents a novel computational algorithm to estimate blood volume decompensation state based on machine learning (ML) analysis of multi-modal wearable-compatible physiological signals. To the best of our knowledge, our algorithm may be the first of its kind which can not only discriminate normovolemia from hypovolemia but also classify hypovolemia into absolute hypovolemia and relative hypovolemia. We realized our blood volume classification algorithm by (i) extracting a multitude of features from multi-modal physiological signals including the electrocardiogram (ECG), the seismocardiogram (SCG), the ballistocardiogram (BCG), and the photoplethysmogram (PPG), (ii) constructing two ML classifiers using the features, one to classify normovolemia vs. hypovolemia and the other to classify hypovolemia into absolute hypovolemia and relative hypovolemia, and (iii) sequentially integrating the two to enable multi-class classification (normovolemia, absolute hypovolemia, and relative hypovolemia). We developed the blood volume decompensation state classification algorithm using the experimental data collected from six animals undergoing normovolemia, relative hypovolemia, and absolute hypovolemia challenges. Leave-one-subject-out analysis showed that our classification algorithm achieved an F1 score and accuracy of (i) 0.93 and 0.89 in classifying normovolemia vs. hypovolemia, (ii) 0.88 and 0.89 in classifying hypovolemia into absolute hypovolemia and relative hypovolemia, and (iii) 0.77 and 0.81 in classifying the overall blood volume decompensation state. The analysis of the features embedded in the ML classifiers indicated that many features are physiologically plausible, and that multi-modal SCG-BCG fusion may play an important role in achieving good blood volume classification efficacy. Our work may complement existing computational algorithms to estimate blood volume compensatory reserve as a potential decision-support tool to provide guidance on context-sensitive hypovolemia therapeutic strategy.