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Lee SW, Park B, Seo J, Lee S, Sim JH. Development of a machine learning approach for prediction of red blood cell transfusion in patients undergoing Cesarean section at a single institution. Sci Rep 2024; 14:16628. [PMID: 39025903 PMCID: PMC11258332 DOI: 10.1038/s41598-024-67784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024] Open
Abstract
Despite recent advances in surgical techniques and perinatal management in obstetrics for reducing intraoperative bleeding, blood transfusion may occur during a cesarean section (CS). This study aims to identify machine learning models with an optimal diagnostic performance for intraoperative transfusion prediction in parturients undergoing a CS. Additionally, to address model performance degradation due to data imbalance, this study further investigated the variation in predictive model performance depending on the ratio of event to non-event data (1:1, 1:2, 1:3, and 1:4 model datasets and raw data).The area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) were evaluated to compare the predictive accuracy of different machine learning algorithms, including XGBoost, K-nearest neighbor, decision tree, support vector machine, multilayer perceptron, logistic regression, random forest, and deep neural network. We compared the predictive performance of eight prediction algorithms that were applied to five types of datasets. The intraoperative transfusion in maternal CS was 7.2% (1020/14,254). XGBoost showed the highest AUROC (0.8257) and AUPRC (0.4825) among the models. The most significant predictors for transfusion in maternal CS as per machine learning models were placenta previa totalis, haemoglobin, placenta previa partialis, and platelets. In all eight prediction algorithms, the change in predictive performance based on the AUROC and AUPRC according to the resampling ratio was insignificant. The XGBoost algorithm exhibited optimal performance for predicting intraoperative transfusion. Data balancing techniques employed to alter the event data composition ratio of the training data failed to improve the performance of the prediction model.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Pungnap 2(i)-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Bumwoo Park
- Big Data Research Center, Asan Medical Center, Seoul, 05505, Republic of Korea
| | - Jimung Seo
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ji-Hoon Sim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Pungnap 2(i)-dong, Songpa-gu, Seoul, 05505, Republic of Korea.
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Zou Y, Zeng S, Huang C, Liu L, Li L. The value of fibrinogen combined with D-dimer and neonatal weight in predicting postpartum hemorrhage in vaginal delivery. J Perinat Med 2024; 52:478-484. [PMID: 38414334 DOI: 10.1515/jpm-2023-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES The purpose of this study was to explore whether fibrinogen (Fib) can be used as a predictor of postpartum hemorrhage (PPH) in parturients with vaginal delivery, and the value of combining Fib with other indexes to predict postpartum hemorrhage in vaginal delivery. METHODS A total of 207 parturients who delivered via vagina were divided into PPH group (n=102) and non-PPH group (n=105). The PPH group was further divided into mild PPH group and severe PPH group. The differences of Fib, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), D-dimer (D-D), hemoglobin (HGB) and neonatal weight (Nw) between the two groups were compared to explore the significance of these indexes in predicting PPH. RESULTS Fib, PLT and PDW in PPH group were significantly lower than those in non-PPH group, while D-D and Nw in PPH group were significantly higher than those in non-PPH group. In the binary logistic regression model, we found that Fib, D-D and Nw were independently related to PPH. The risk of PPH increased by 9.87 times for every 1 g/L decrease in Fib. The cut-off value of Fib is 4.395 (sensitivity 0.705, specificity 0.922). The AUC value of PPH predicted by Fib combined with D-D and Nw was significantly higher than that of PPH predicted by Fib (p<0.05, 95 % CI 0.00313-0.0587). CONCLUSIONS Fib, D-D and Nw have good predictive value for PPH of vaginal delivery, among which Fib is the best. The combination of three indexes of Fib, D-D and Nw can predict PPH more systematically and comprehensively, and provide a basis for clinical prevention and treatment of PPH.
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Affiliation(s)
- Yanke Zou
- Department of Cardiology, Army Medical Center of PLA, Chongqing, P.R. China
| | - Shuai Zeng
- Department of Laboratory Pathology, Unit 32280 of the People's Liberation Army, Leshan City, Sichuan Province, P.R. China
| | - Changxiao Huang
- Department of Obstetrics and Gynecology, Army Medical Center of PLA, Chongqing, P.R. China
| | - Ling Liu
- Department of Health Statistics, Army Military Medical University, Chongqing, P.R. China
| | - Li Li
- Department of Obstetrics and Gynecology, Army Medical Center of PLA, Chongqing, P.R. China
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Wang M, Yi G, Zhang Y, Li M, Zhang J. Quantitative prediction of postpartum hemorrhage in cesarean section on machine learning. BMC Med Inform Decis Mak 2024; 24:166. [PMID: 38872184 DOI: 10.1186/s12911-024-02571-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Cesarean section-induced postpartum hemorrhage (PPH) potentially causes anemia and hypovolemic shock in pregnant women. Hence, it is helpful for obstetricians and anesthesiologists to prepare pre-emptive prevention when predicting PPH occurrence in advance. However, current works on PPH prediction focus on whether PPH occurs rather than assessing PPH amount. To this end, this work studies quantitative PPH prediction with machine learning (ML). METHODS The study cohort in this paper was selected from individuals with PPH who were hospitalized at Shijiazhuang Obstetrics and Gynecology Hospital from 2020 to 2022. In this study cohort, we built a dataset with 6,144 subjects covering clinical parameters, anesthesia operation records, laboratory examination results, and other information in the electronic medical record system. Based on our built dataset, we exploit six different ML models, including logistic regression, linear regression, gradient boosting, XGBoost, multilayer perceptron, and random forest, to automatically predict the amount of bleeding during cesarean section. Eighty percent of the dataset was used as model training, and 20 % was used for verification. Those ML models are constantly verified and improved by root mean squared error(RMSE) and mean absolute error(MAE). Moreover, we also leverage the importance of permutation and partial dependence plot (PDP) to discuss their feasibility. RESULT The experiment results show that random forest obtains the highest accuracy for PPH amount prediction compared to other ML methods. Random forest reaches the mean absolute error of 21.7, less than 5.4 % prediction error. It also gains the root mean squared error of 33.75, less than 9.3 % prediction error. On the other hand, the experimental results also disclose indicators that contributed most to PPH prediction, including Ca, hemoglobin, white blood cells, platelets, Na, and K. CONCLUSION It effectively predicts the amount of PPH during a cesarean section by ML methods, especially random forest. With the above insight, ML predicting PPH amounts provides early warning for clinicians, thus reducing complications and improving cesarean sections' safety. Furthermore, the importance of ML and permutation, complemented by incorporating PDP, promises to provide clinicians with a transparent indication of individual risk prediction.
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Affiliation(s)
- Meng Wang
- School of Information Engineering, China University of Geosciences, Beijing, 100083, China
- Tangshan Polytechnic College, Tangshan, 063299, China
| | - Gao Yi
- Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, 050000, China
| | - Yunjia Zhang
- School of Information Engineering, China University of Geosciences, Beijing, 100083, China
| | - Mei Li
- School of Information Engineering, China University of Geosciences, Beijing, 100083, China.
| | - Jin Zhang
- Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, 050000, China.
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Bai J, Lu Y, Liu H, He F, Guo X. Editorial: New technologies improve maternal and newborn safety. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1372358. [PMID: 38872737 PMCID: PMC11169838 DOI: 10.3389/fmedt.2024.1372358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Jieyun Bai
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, China
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Yaosheng Lu
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Information Technology, Jinan University, Guangzhou, China
| | - Huishu Liu
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fang He
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaohui Guo
- Department of Obstetrics, Shenzhen People’s Hospital, Shenzhen, China
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Yagin FH, Alkhateeb A, Raza A, Samee NA, Mahmoud NF, Colak C, Yagin B. An Explainable Artificial Intelligence Model Proposed for the Prediction of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and the Identification of Distinctive Metabolites. Diagnostics (Basel) 2023; 13:3495. [PMID: 38066735 PMCID: PMC10706650 DOI: 10.3390/diagnostics13233495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and debilitating illness with a significant global prevalence, affecting over 65 million individuals. It affects various systems, including the immune, neurological, gastrointestinal, and circulatory systems. Studies have shown abnormalities in immune cell types, increased inflammatory cytokines, and brain abnormalities. Further research is needed to identify consistent biomarkers and develop targeted therapies. This study uses explainable artificial intelligence and machine learning techniques to identify discriminative metabolites for ME/CFS. MATERIAL AND METHODS The model investigates a metabolomics dataset of CFS patients and healthy controls, including 26 healthy controls and 26 ME/CFS patients aged 22-72. The dataset encapsulated 768 metabolites into nine metabolic super-pathways: amino acids, carbohydrates, cofactors, vitamins, energy, lipids, nucleotides, peptides, and xenobiotics. Random forest methods together with other classifiers were applied to the data to classify individuals as ME/CFS patients and healthy individuals. The classification learning algorithms' performance in the validation step was evaluated using a variety of methods, including the traditional hold-out validation method, as well as the more modern cross-validation and bootstrap methods. Explainable artificial intelligence approaches were applied to clinically explain the optimum model's prediction decisions. RESULTS The metabolomics of C-glycosyltryptophan, oleoylcholine, cortisone, and 3-hydroxydecanoate were determined to be crucial for ME/CFS diagnosis. The random forest model outperformed the other classifiers in ME/CFS prediction using the 1000-iteration bootstrapping method, achieving 98% accuracy, precision, recall, F1 score, 0.01 Brier score, and 99% AUC. According to the obtained results, the bootstrap validation approach demonstrated the highest classification outcomes. CONCLUSION The proposed model accurately classifies ME/CFS patients based on the selected biomarker candidate metabolites. It offers a clear interpretation of risk estimation for ME/CFS, aiding physicians in comprehending the significance of key metabolomic features within the model.
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Affiliation(s)
- Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Türkiye;
| | | | - Ali Raza
- Institute of Computer Science, Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Khan 64200, Pakistan;
| | - Nagwan Abdel Samee
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Noha F. Mahmoud
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Türkiye;
| | - Burak Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Türkiye;
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Xu L, Liu Z, Ma N, Chen J, Shen J, Chen X, Zhao C. Development and validation of an artificial neural network prediction model for postpartum hemorrhage with placenta previa. Minerva Anestesiol 2023; 89:977-985. [PMID: 37378626 DOI: 10.23736/s0375-9393.23.17366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity worldwide and placenta previa is one of the major risk factors for PPH in overall population. However, the clinical prediction of PPH remains challenging. This study aimed to investigate an ideal machine learning-based prediction model for PPH in placenta previa parturients with cesarean section. METHODS The clinical data of 223 placenta previa parturients who underwent cesarean delivery in our hospital from 2016 to 2019 were retrospectively collected for analysis. An artificial neural network model was designed to predict PPH, defined as blood loss exceeding 1000 mL with 24h after delivery. Twenty clinical variables were selected as predictors. We also applied six conventional machine learning methods as reference models, including support vector machine, decision tree, random forest, gradient boosting decision tree, adaboost and logistic regression. All the models were validated using 5-fold cross-validation. The area under the receiver operating characteristic curve (AUC), precision, recall and the prediction accuracy of each model were reported. RESULTS A total of 223 pregnant women were enrolled in this study, including 101 cases (45.29%) experienced PPH. The proposed model achieved superior prediction performance with an AUC of 0.917, an accuracy of 0.851, a precision score of 0.829 and a recall score of 0.851, which outperformed other six conventional machine learning methods. CONCLUSIONS Compared to the conventional machine learning approaches, artificial neural network model shows discriminative ability in identifying women's risk of PPH with placenta previa during cesarean section.
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Affiliation(s)
- Lili Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China -
| | - Zihang Liu
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou, China
| | - Na Ma
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junyao Chen
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Jianjun Shen
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunhui Zhao
- State Key Laboratory of Industrial Control Technology, College of Control Science and Engineering, Zhejiang University, Hangzhou, China
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Mehrnoush V, Ranjbar A, Farashah MV, Darsareh F, Shekari M, Jahromi MS. Prediction of postpartum hemorrhage using traditional statistical analysis and a machine learning approach. AJOG GLOBAL REPORTS 2023; 3:100185. [PMID: 36935935 PMCID: PMC10020099 DOI: 10.1016/j.xagr.2023.100185] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Early detection of postpartum hemorrhage risk factors by healthcare providers during pregnancy and the postpartum period may allow healthcare providers to act to prevent it. Developing a prediction model that incorporates several risk factors and accurately calculates the overall risk for postpartum hemorrhage is necessary. OBJECTIVE This study used a traditional analytical approach and a machine learning model to predict postpartum hemorrhage. STUDY DESIGN Women who gave birth at the Khaleej-e-Fars Hospital in Bandar Abbas, Iran, were evaluated retrospectively between January 1, 2020, and January 1, 2022. These pregnant women were divided into 2 groups, namely those who had postpartum hemorrhage and those who did not. We used 2 approaches for the analysis. At the first level, we used the traditional analysis methods. Demographic factors, maternal comorbidities, and obstetrical factors were compared between the 2 groups. A bivariate logistic regression analysis of the risk factors for postpartum hemorrhage was done to estimate the crude odds ratios and their 95% confidence intervals. In the second level, we used machine learning approaches to predict postpartum hemorrhage. RESULTS Of the 8888 deliveries, we identified 163 women with recorded postpartum hemorrhage, giving a frequency of 1.8%. According to a traditional analysis, factors associated with an increased risk for postpartum hemorrhage in a bivariate logistic regression analysis were living in a rural area (odds ratio, 1.41; 95% confidence interval, 1.08-1.98); primiparity (odds ratio, 3.16; 95% confidence interval, 1.90-4.75); mild to moderate anemia (odds ratio, 5.94; 95% confidence interval 2.81-8.34); severe anemia (odds ratio, 6.01; 95% confidence interval 3.89-11.09); abnormal placentation (odds ratio, 7.66; 95% confidence interval, 2.81-17.34); fetal macrosomia (odds ratio, 8.14; 95% confidence interval, 1.02-14.47); shoulder dystocia (odds ratio, 7.88; 95% confidence interval, 1.07-13.99); vacuum delivery (odds ratio, 2.01; 95% confidence interval, 1.15-5.98); cesarean delivery (odds ratio, 1.86; 95% confidence interval, 1.12-3.79); and general anesthesia during cesarean delivery (odds ratio, 7.66; 95 % confidence interval, 3.11-9.36). According to machine learning analysis, the top 5 algorithms were XGBoost regression (area under the receiver operating characteristic curve of 99%), XGBoost classification (area under the receiver operating characteristic curve of 98%), LightGBM (area under the receiver operating characteristic curve of 94%), random forest regression (area under the receiver operating characteristic curve of 86%), and linear regression (area under the receiver operating characteristic curve of 78%). However, after considering all performance parameters, the XGBoost classification was found to be the best model to predict postpartum hemorrhage. The importance of the variables in the linear regression model, similar to traditional analysis methods, revealed that macrosomia, general anesthesia, anemia, shoulder dystocia, and abnormal placentation were considered to be weighted factors, whereas XGBoost classification considered living residency, parity, cesarean delivery, education, and induced labor to be weighted factors. CONCLUSION Risk factors for postpartum hemorrhage can be identified using traditional statistical analysis and a machine learning model. Machine learning models were a credible approach for improving postpartum hemorrhage prediction with high accuracy. More research should be conducted to analyze appropriate variables and prepare big data to determine the best model.
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Affiliation(s)
- Vahid Mehrnoush
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Drs Mehrnoush and Darsareh and Mses Shekari and Jahromi)
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada (Dr Mehrnoush)
| | - Amene Ranjbar
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Dr Ranjbar)
| | | | - Fatemeh Darsareh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Drs Mehrnoush and Darsareh and Mses Shekari and Jahromi)
- Corresponding author: Fatemeh Darsareh, PhD.
| | - Mitra Shekari
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Drs Mehrnoush and Darsareh and Mses Shekari and Jahromi)
| | - Malihe Shirzadfard Jahromi
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Drs Mehrnoush and Darsareh and Mses Shekari and Jahromi)
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Hu X, Yang Z, Ma Y, Wang M, Liu W, Qu G, Zhong C. Development and validation of a machine learning-based predictive model for secondary post-tonsillectomy hemorrhage. Front Surg 2023; 10:1114922. [PMID: 36824494 PMCID: PMC9941337 DOI: 10.3389/fsurg.2023.1114922] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Background The main obstacle to a patient's recovery following a tonsillectomy is complications, and bleeding is the most frequent culprit. Predicting post-tonsillectomy hemorrhage (PTH) allows for accurate identification of high-risk populations and the implementation of protective measures. Our study aimed to investigate how well machine learning models predict the risk of PTH. Methods Data were obtained from 520 patients who underwent a tonsillectomy at The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army. The age range of the patients was 2-57 years, and 364 (70%) were male. The prediction models were developed using five machine learning models: decision tree, support vector machine (SVM), extreme gradient boosting (XGBoost), random forest, and logistic regression. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was used to interpret the results of the best-performing model. Results The frequency of PTH was 11.54% among the 520 patients, with 10.71% in the training group and 13.46% in the validation set. Age, BMI, season, smoking, blood type, INR, combined secretory otitis media, combined adenoidectomy, surgical wound, and use of glucocorticoids were selected by mutual information (MI) method. The XGBoost model had best AUC (0.812) and Brier score (0.152). Decision curve analysis (DCA) showed that the model had a high clinical utility. The SHAP method revealed the top 10 variables of MI according to the importance ranking, and the average of the age was recognized as the most important predictor variable. Conclusion This study built a PTH risk prediction model using machine learning. The XGBoost model is a tool with potential to facilitate population management strategies for PTH.
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Affiliation(s)
- Xiandou Hu
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Zixuan Yang
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Yuhu Ma
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Mengqi Wang
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Weijie Liu
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China,School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Gaoya Qu
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Cuiping Zhong
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China,Correspondence: Cuiping Zhong
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