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Zhang S, Lu G, Wang W, Li Q, Wang R, Zhang Z, Wu X, Liang C, Liu Y, Li P, Wen Q, Cui B, Zhang F. A predictive machine-learning model for clinical decision-making in washed microbiota transplantation on ulcerative colitis. Comput Struct Biotechnol J 2024; 24:583-592. [PMID: 39281978 PMCID: PMC11399476 DOI: 10.1016/j.csbj.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
Machine learning based on clinical data and treatment protocols for better clinical decision-making is a current research hotspot. This study aimed to build a machine learning model on washed microbiota transplantation (WMT) for ulcerative colitis (UC), providing patients and clinicians with a new evaluation system to optimize clinical decision-making. Methods Patients with UC who underwent WMT via mid-gut or colonic delivery route at an affiliated hospital of Nanjing Medical University from April 2013 to June 2022 were recruited. Model ensembles based on the clinical indicators were constructed by machine-learning to predict the clinical response of WMT after one month. Results A total of 366 patients were enrolled in this study, with 210 patients allocated for training and internal validation, and 156 patients for external validation. The low level of indirect bilirubin, activated antithrombin III, defecation frequency and cholinesterase and the elderly and high level of creatine kinase, HCO3 - and thrombin time were related to the clinical response of WMT at one month. Besides, the voting ensembles exhibited an area under curve (AUC) of 0.769 ± 0.019 [accuracy, 0.754; F1-score, 0.845] in the internal validation; the AUC of the external validation was 0.614 ± 0.017 [accuracy, 0.801; F1-score, 0.887]. Additionally, the model was available at https://wmtpredict.streamlit.app. Conclusions This study pioneered the development of a machine learning model to predict the one-month clinical response of WMT on UC. The findings demonstrate the potential value of machine learning applications in the field of WMT, opening new avenues for personalized treatment strategies in gastrointestinal disorders. Trial registration clinical trials, NCT01790061. Registered 09 February 2013 - Retrospectively registered, https://clinicaltrials.gov/study/NCT01790061.
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Affiliation(s)
- Sheng Zhang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gaochen Lu
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weihong Wang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qianqian Li
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Wang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zulun Zhang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xia Wu
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chenchen Liang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yujie Liu
- Department of Medicine & Therapeutics, the Chinese University of Hong Kong, Hong Kong, China
| | - Pan Li
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Wen
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bota Cui
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Faming Zhang
- Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Engineering Research Center for Advanced Microbiota Medicine, Key Lab of Holistic Integrative Enterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- National Clinical Research Center for Digestive Diseases, Xi'an, China
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Rees CA, Kisenge R, Godfrey E, Ideh RC, Kamara J, Coleman-Nekar YJ, Samma A, Manji HK, Sudfeld CR, Westbrook A, Niescierenko M, Morris CR, Whitney CG, Breiman RF, Duggan CP, Manji KP. Derivation and Internal Validation of a Novel Risk Assessment Tool to Identify Infants and Young Children at Risk for Post-Discharge Mortality in Dar es Salaam, Tanzania and Monrovia, Liberia. J Pediatr 2024; 273:114147. [PMID: 38878962 PMCID: PMC11415288 DOI: 10.1016/j.jpeds.2024.114147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To derive and validate internally a novel risk assessment tool to identify young children at risk for all-cause mortality ≤60 days of discharge from hospitals in sub-Saharan Africa. STUDY DESIGN We performed a prospective observational cohort study of children aged 1-59 months discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia (2019-2022). Caregivers received telephone calls up to 60 days after discharge to ascertain participant vital status. We collected socioeconomic, demographic, clinical, and anthropometric data during hospitalization. Candidate variables with P < .20 in bivariate analyses were included in a multivariable logistic regression model with best subset selection to identify risk factors for the outcome. We internally validated our tool using bootstrapping with 500 repetitions. RESULTS There were 1933 young children enrolled in the study. The median (IQR) age was 11 (4, 23) months and 58.7% were males. In total, 67 (3.5%) died during follow-up. Ten variables contributed to our tool (total possible score 82). Cancer (aOR 10.6, 95% CI 2.58, 34.6), pedal edema (aOR 6.94, 95% CI 1.69, 22.6), and leaving against medical advice (aOR 6.46, 95% CI 2.46, 15.3) were most predictive of post-discharge mortality. Our risk assessment tool demonstrated good discriminatory value (optimism corrected area under the receiver operating characteristic curve 0.77), high precision, and sufficient calibration. CONCLUSIONS After validation, this tool may be used to identify young children at risk for post-discharge mortality to direct resources for follow-up of high-risk children.
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Affiliation(s)
- Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Evance Godfrey
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Readon C Ideh
- Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia
| | - Julia Kamara
- Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia
| | | | - Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hussein K Manji
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Accident and Emergency Department, The Aga Khan Health Services, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Adrianna Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
| | - Claudia R Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Robert F Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Christopher P Duggan
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology, and Nutrition, Center for Nutrition, Boston Children's Hospital, Boston, MA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Jauk S, Kramer D, Sumerauer S, Veeranki SPK, Schrempf M, Puchwein P. Machine learning-based delirium prediction in surgical in-patients: a prospective validation study. JAMIA Open 2024; 7:ooae091. [PMID: 39297150 PMCID: PMC11408728 DOI: 10.1093/jamiaopen/ooae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/20/2024] [Accepted: 09/12/2024] [Indexed: 09/21/2024] Open
Abstract
Objective Delirium is a syndrome that leads to severe complications in hospitalized patients, but is considered preventable in many cases. One of the biggest challenges is to identify patients at risk in a hectic clinical routine, as most screening tools cause additional workload. The aim of this study was to validate a machine learning (ML)-based delirium prediction tool on surgical in-patients undergoing a systematic assessment of delirium. Materials and Methods 738 in-patients of a vascular surgery, a trauma surgery and an orthopedic surgery department were screened for delirium using the DOS scale twice a day over their hospital stay. Concurrently, delirium risk was predicted by the ML algorithm in real-time for all patients at admission and evening of admission. The prediction was performed automatically based on existing EHR data and without any additional documentation needed. Results 103 patients (14.0%) were screened positive for delirium using the DOS scale. Out of them, 85 (82.5%) were correctly identified by the ML algorithm. Specificity was slightly lower, detecting 463 (72.9%) out of 635 patients without delirium. The AUROC of the algorithm was 0.883 (95% CI, 0.8523-0.9147). Discussion In this prospective validation study, the implemented machine-learning algorithm was able to detect patients with delirium in surgical departments with high discriminative performance. Conclusion In future, this tool or similar decision support systems may help to replace time-intensive screening tools and enable efficient prevention of delirium.
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Affiliation(s)
- Stefanie Jauk
- Division of Technology and IT, Steiermärkische Krankenanstaltengesellschaft m.b.H. (KAGes), 8010 Graz, Austria
- PH Predicting Health GmbH, 8010 Graz, Austria
| | - Diether Kramer
- Division of Technology and IT, Steiermärkische Krankenanstaltengesellschaft m.b.H. (KAGes), 8010 Graz, Austria
- PH Predicting Health GmbH, 8010 Graz, Austria
| | - Stefan Sumerauer
- Department of Neurology, Steiermärkische Krankenanstaltengesellschaft m.b.H. (KAGes), 8036 Graz, Austria
| | - Sai Pavan Kumar Veeranki
- Division of Technology and IT, Steiermärkische Krankenanstaltengesellschaft m.b.H. (KAGes), 8010 Graz, Austria
- PH Predicting Health GmbH, 8010 Graz, Austria
| | | | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
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Chen YC, Zheng J, Zhou F, Tao XW, Chen Q, Feng Y, Su YY, Zhang Y, Liu T, Zhou CS, Tang CX, Weir-McCall J, Teng Z, Zhang LJ. Coronary CTA-based vascular radiomics predicts atherosclerosis development proximal to LAD myocardial bridging. Eur Heart J Cardiovasc Imaging 2024; 25:1462-1471. [PMID: 38781436 DOI: 10.1093/ehjci/jeae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS Cardiac cycle morphological changes can accelerate plaque growth proximal to myocardial bridging (MB) in the left anterior descending artery (LAD). To assess coronary computed tomography angiography (CCTA)-based vascular radiomics for predicting proximal plaque development in LAD MB. METHODS AND RESULTS Patients with repeated CCTA scans showing LAD MB without proximal plaque in index CCTA were included from Jinling Hospital as a development set. They were divided into training and internal testing in an 8:2 ratio. Patients from four other tertiary hospitals were set as external validation set. The endpoint was proximal plaque development of LAD MB in follow-up CCTA. Four vascular radiomics models were built: MB centreline (MB CL), proximal MB CL (pMB CL), MB cross-section (MB CS), and proximal MB CS (pMB CS), whose performances were evaluated using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI). In total, 295 patients were included in the development (n = 192; median age, 54 ± 11 years; 137 men) and external validation sets (n = 103; median age, 57 ± 9 years; 57 men). The pMB CS vascular radiomics model exhibited higher AUCs in training, internal test, and external sets (AUC = 0.78, 0.75, 0.75) than the clinical and anatomical model (all P < 0.05). Integration of the pMB CS vascular radiomics model significantly raised the AUC of the clinical and anatomical model from 0.56 to 0.75 (P = 0.002), along with enhanced NRI [0.76 (0.37-1.14), P < 0.001] and IDI [0.17 (0.07-0.26), P < 0.001] in the external validation set. CONCLUSION The CCTA-based pMB CS vascular radiomics model can predict plaque development in LAD MB.
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Affiliation(s)
- Yan Chun Chen
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | - Jin Zheng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | | | - Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China
| | - Yun Feng
- Department of Radiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu 223001, China
| | - Yun Yan Su
- Department of Radiology, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Gusu District, Suzhou, Jiangsu 215006, China
| | - Yu Zhang
- Outpatient Department of Military, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
| | - Tongyuan Liu
- Department of Radiology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, China
| | - Chang Sheng Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
| | - Jonathan Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Royal Papworth Hospital, Cambridge, UK
| | - Zhongzhao Teng
- Nanjing Jingsan Medical Science and Technology, Ltd., Nanjing, Jiangsu, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China
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Saboorifar H, Rahimi M, Babaahmadi P, Farokhzadeh A, Behjat M, Tarokhian A. Acute cholecystitis diagnosis in the emergency department: an artificial intelligence-based approach. Langenbecks Arch Surg 2024; 409:288. [PMID: 39316140 DOI: 10.1007/s00423-024-03475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVES This study aimed to assess the diagnostic performance of a support vector machine (SVM) algorithm for acute cholecystitis and evaluate its effectiveness in accurately diagnosing this condition. METHODS Using a retrospective analysis of patient data from a single center, individuals with abdominal pain lasting one week or less were included. The SVM model was trained and optimized using standard procedures. Model performance was assessed through sensitivity, specificity, accuracy, and AUC-ROC, with probability calibration evaluated using the Brier score. RESULTS Among 534 patients, 198 (37.07%) were diagnosed with acute cholecystitis. The SVM model showed balanced performance, with a sensitivity of 83.08% (95% CI: 71.73-91.24%), a specificity of 80.21% (95% CI: 70.83-87.64%), and an accuracy of 81.37% (95% CI: 74.48-87.06%). The positive predictive value (PPV) was 73.97% (95% CI: 65.18-81.18%), the negative predictive value (NPV) was 87.50% (95% CI: 80.19-92.37%), and the AUC-ROC was 0.89 (95% CI: 0.85 to 0.93). The Brier score indicated well-calibrated probability estimates. CONCLUSION The SVM algorithm demonstrated promising potential for accurately diagnosing acute cholecystitis. Further refinement and validation are needed to enhance its reliability in clinical practice.
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Affiliation(s)
- Hossein Saboorifar
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Rahimi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Paria Babaahmadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asal Farokhzadeh
- Department of General Surgery, Farhikhtegan Hospital, School of Medicine, Azad University of Medical Sciences, Tehran, Iran
| | - Morteza Behjat
- School of Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Tarokhian
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.
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Jeon ET, Lee SH, Eun MY, Jung JM. Center of Pressure- and Machine Learning-based Gait Score and Clinical Risk Factors for Predicting Functional Outcome in Acute Ischemic Stroke. Arch Phys Med Rehabil 2024:S0003-9993(24)01183-3. [PMID: 39187003 DOI: 10.1016/j.apmr.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES To investigate whether machine learning (ML)-based center of pressure (COP) analysis for gait assessment, when used in conjunction with clinical information, offers additive benefits in predicting functional outcomes in patients with acute ischemic stroke. DESIGN A prospective, single-center cohort study. SETTING A tertiary hospital setting. PARTICIPANTS A total of 185 patients with acute ischemic stroke, capable of walking 10 m with or without a gait aid by day 7 postadmission. From these patients, 10,804 pairs of consecutive footfalls were included for analysis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variable was a 3-month poor functional outcome, defined as modified Rankin scale score ≥2. For independent variables, 65 clinical variables including demographics, anthropometrics, comorbidities, laboratory data, questionnaires, and drug history were included. Gait function was evaluated using a pressure-sensitive mat. Time-series COP data were parameterized into spatial and temporal variables and analyzed with logistic regression and 2 ML models (light gradient-boosting machine and multilayer perceptron [MLP]). We derived GAIT-AI output scores from the best-performing model analyzed COP data and constructed multivariable logistic regression models using clinical variables and the GAIT scores. RESULTS Among the included patients, 70 (37.8%) experienced unfavorable outcomes. The MLP model demonstrated the highest predictive performance with an area under the receiver operating characteristic curve (AUROC) of 0.799. Multivariable logistic regression identified age, initial National Institutes of Health Stroke Scale, and initial Fall Efficacy Scale-International as associated factors with unfavorable outcomes. The combined multivariable logistic regression incorporating COP-derived output scores improved the AUROC to 0.812. CONCLUSIONS Gait function, assessed through COP analysis, serves as a significant predictor of functional outcome in patients with acute ischemic stroke. ML-based COP analysis, when combined with clinical data, enhances the prediction of poor functional outcomes.
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Affiliation(s)
- Eun-Tae Jeon
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan
| | - Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan
| | - Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, Daegu; Department of Neurology, School of Medicine, Kyungpook National University, Daegu; Department of Neurology, Graduate School, Korea University, Seoul
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan; Korea University Zebrafish Translational Medical Research Center, Ansan, South Korea.
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Zeng H, Chen Y, Zhao J, Dai J, Xie Y, Wang M, Wang Q, Xu N, Chen J, Sun G, Zeng H, Shen P. Development and validation of a novel nomogram to avoid unnecessary biopsy in patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml. World J Urol 2024; 42:495. [PMID: 39177844 DOI: 10.1007/s00345-024-05202-y] [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: 05/10/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES To develop and validate a prediction model for identifying non-prostate cancer (non-PCa) in biopsy-naive patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml to avoid unnecessary biopsy. PATIENTS AND METHODS Eligible patients who underwent transperineal biopsies at West China Hospital between 2018 and 2022 were included. The patients were randomly divided into training cohort (70%) and validation cohort (30%). Logistic regression was used to screen for independent predictors of non-PCa, and a nomogram was constructed based on the regression coefficients. The discrimination and calibration were assessed by the C-index and calibration plots, respectively. Decision curve analysis (DCA) and clinical impact curves (CIC) were applied to measure the clinical net benefit. RESULTS A total of 1580 patients were included, with 634 non-PCa. Age, prostate volume, prostate-specific antigen density (PSAD), apparent diffusion coefficient (ADC) and lesion zone were independent predictors incorporated into the optimal prediction model, and a corresponding nomogram was constructed ( https://nomogramscu.shinyapps.io/PI-RADS-4-5/ ). The model achieved a C-index of 0.931 (95% CI, 0.910-0.953) in the validation cohort. The DCA and CIC demonstrated an increased net benefit over a wide range of threshold probabilities. At biopsy-free thresholds of 60%, 70%, and 80%, the nomogram was able to avoid 74.0%, 65.8%, and 55.6% of unnecessary biopsies against 9.0%, 5.0%, and 3.6% of missed PCa (or 35.9%, 30.2% and 25.1% of foregone biopsies, respectively). CONCLUSION The developed nomogram has favorable predictive capability and clinical utility can help identify non-PCa to support clinical decision-making and reduce unnecessary prostate biopsies.
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Affiliation(s)
- Hong Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuntian Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yandong Xie
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Minghao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Nanwei Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Junru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Barfejani AH, Rahimi M, Safdari H, Gholizadeh S, Borzooei S, Roshanaei G, Golparian M, Tarokhian A. Thy-DAMP: deep artificial neural network model for prediction of thyroid cancer mortality. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08918-0. [PMID: 39174681 DOI: 10.1007/s00405-024-08918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Despite the rising incidence of differentiated thyroid cancer (DTC), mortality rates have remained relatively low yet crucial for effective patient management. This study aims to develop a deep neural network capable of predicting mortality in patients with differentiated thyroid cancer. METHODS Leveraging data from the Surveillance, Epidemiology, and End Results (SEER) database, we developed Thy-DAMP (Deep Artificial Neural Network Model for Prediction of Thyroid Cancer) to forecast mortality in DTC patients. The dataset comprised demographic, histologic, and staging information. Following data normalization and feature encoding, the dataset was partitioned into training, testing, and validation subsets, with model hyperparameters fine-tuned via cross-validation. RESULTS Among the 63,513 patients, the mean age was 48.22 years (SD = 14.8), with 77.32% being female. Papillary carcinoma emerged as the predominant subtype, representing 62.94% of cases. The majority presented with stage I disease (73.96%). Thy-DAMP demonstrated acceptable performance metrics on both the test and validation sets. Sensitivity was 83.24% (95% CI 76.95-88.40%), specificity was 93.53% (95% CI 93.01-94.02%), and accuracy stood at 93.33% (95% CI 92.82-93.83%). The model exhibited a positive predictive value of 19.76% (95% CI 18.20-21.42%) and a negative predictive value of 99.66% (95% CI 99.53-99.75%). Additionally, Thy-DAMP demonstrated a positive likelihood ratio of 12.86 (95% CI 11.62-14.23), a negative likelihood ratio of 0.18 (95% CI 0.13-0.25), and an area under the receiver operating characteristic curve (AUROC) of 0.95. The model was externally validated on a separate dataset with nearly identical performance. CONCLUSION Thy-DAMP showcases considerable promise in accurately predicting mortality in DTC patients, leveraging limited set of patient data.
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Affiliation(s)
| | - Mohammad Rahimi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hassan Safdari
- Department of Anesthesiology and Preioperative Medicine, Tufts Medical Center, Boston, USA
| | | | - Shiva Borzooei
- Department of Endocrinology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghodratollah Roshanaei
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mitra Golparian
- Medical School, Hamadan University of Medical Sciences, Pajoohesh Blvd, Hamadan, Iran
| | - Aidin Tarokhian
- Medical School, Hamadan University of Medical Sciences, Pajoohesh Blvd, Hamadan, Iran.
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9
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Roshanaei G, Salimi R, Mahjub H, Faradmal J, Yamini A, Tarokhian A. Accurate diagnosis of acute appendicitis in the emergency department: an artificial intelligence-based approach. Intern Emerg Med 2024:10.1007/s11739-024-03738-w. [PMID: 39167270 DOI: 10.1007/s11739-024-03738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/03/2024] [Indexed: 08/23/2024]
Abstract
The diagnosis of abdominal pain in emergency departments is challenging, and appendicitis is a common concern. Atypical symptoms often delay diagnosis. Although the Alvarado score aids in decision-making, its low specificity can lead to unnecessary surgeries. By leveraging machine learning, we aim to enhance diagnostic accuracy by predicting appendicitis and distinguishing it from other causes of abdominal pain in the emergency department. Data were collected from 534 patients who presented with acute abdominal pain. Patient characteristics, laboratory results, and causes of pain were recorded. Machine learning algorithms (support vector classifier, random forest classifier, gradient boosting classifier, and Gaussian naive Bayes) were used to predict the cause of pain. Model calibration was assessed using the Brier score. The mean age was 46.89 (20.3) years, with an almost equal sex distribution (49% male, 51% female). Cholecystitis was the most prevalent outcome (37.07%), followed by appendicitis (25.84%). The Gaussian naive Bayes model exhibited superior performance in terms of accuracy (95.03% 95% CI 90.44-97.83%), sensitivity (87.18% 95% CI 72.57-95.70%), and specificity (97.54% 95% CI 92.98-99.49%), while the random forest model showed a sensitivity of 79.49%, specificity of 96.72%, and accuracy of 92.55%. The gradient boosting algorithm achieved a sensitivity, specificity, and accuracy of 89.74%, 95.90%, and 94.41%, respectively. The support vector classifier demonstrated a sensitivity of 89.74%, specificity of 92.62%, and accuracy of 91.93%. The use of modern machine learning methods aids in the accurate diagnosis of appendicitis.
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Affiliation(s)
- Ghodratollah Roshanaei
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rasoul Salimi
- Emergency Department, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Mahjub
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Yamini
- Department of General Surgery, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Aidin Tarokhian
- Hamadan University of Medical Sciences, Pajoohesh Blvd, Hamadan, Iran.
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10
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Im J, Soliman MAR, Aguirre AO, Quiceno E, Burns E, Khan AMA, Kuo CC, Baig RA, Khan A, Hess RM, Pollina J, Mullin JP. American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator as a Predictor of Postoperative Outcomes After Adult Spinal Deformity Surgery: A Retrospective Cohort Analysis. Neurosurgery 2024:00006123-990000000-01249. [PMID: 38934614 DOI: 10.1227/neu.0000000000003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/01/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In recent years, there has been an outpouring of scoring systems that were built to predict outcomes after various surgical procedures; however, research validating these studies in spinal surgery is quite limited. In this study, we evaluated the predictability of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP SRC) for various postoperative outcomes after spinal deformity surgery. METHODS A retrospective chart review was conducted to identify patients who underwent spinal deformity surgery at our hospital between January 1, 2014, and December 31, 2022. Demographic and clinical data necessary to use the ACS NSQIP SRC and postoperative outcomes were collected for these patients. Predictability was analyzed using the area under the curve (AUC) of receiver operating characteristic curves and Brier scores. RESULTS Among the 159 study patients, the mean age was 64.5 ± 9.5 years, mean body mass index was 31.9 ± 6.6, and 95 (59.7%) patients were women. The outcome most accurately predicted by the ACS NSQIP SRC was postoperative pneumonia (observed = 5.0% vs predicted = 3.2%, AUC = 0.75, Brier score = 0.05), but its predictability still fell below the acceptable threshold. Other outcomes that were underpredicted by the ACS NSQIP SRC were readmission within 30 days (observed = 13.8% vs predicted = 9.0%, AUC = 0.63, Brier score = 0.12), rate of discharge to nursing home or rehabilitation facilities (observed = 56.0% vs predicted = 46.6%, AUC = 0.59, Brier = 0.26), reoperation (observed 11.9% vs predicted 5.4%, AUC = 0.60, Brier = 0.11), surgical site infection (observed 9.4% vs predicted 3.5%, AUC = 0.61, Brier = 0.05), and any complication (observed 33.3% vs 19%, AUC = 0.65, Brier = 0.23). Predicted and observed length of stay were not significantly associated (β = 0.132, P = .47). CONCLUSION The ACS NSQIP SRC is a poor predictor of outcomes after spinal deformity surgery.
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Affiliation(s)
- Justin Im
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Evan Burns
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Ali M A Khan
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Rehman A Baig
- Current Affiliation: Department of Neurosurgery, Imperial College, London, UK
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
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11
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Viljanen M, Tostrams L, Schoffelen N, van de Kassteele J, Marshall L, Moens M, Beukema W, Wamelink W. A joint model for the estimation of species distributions and environmental characteristics from point-referenced data. PLoS One 2024; 19:e0304942. [PMID: 38905294 PMCID: PMC11192322 DOI: 10.1371/journal.pone.0304942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/21/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Predicting and explaining species occurrence using environmental characteristics is essential for nature conservation and management. Species distribution models consider species occurrence as the dependent variable and environmental conditions as the independent variables. Suitable conditions are estimated based on a sample of species observations, where one assumes that the underlying environmental conditions are known. This is not always the case, as environmental variables at broad spatial scales are regularly extrapolated from point-referenced data. However, treating the predicted environmental conditions as accurate surveys of independent variables at a specific point does not take into account their uncertainty. METHODS We present a joint hierarchical Bayesian model where models for the environmental variables, rather than a set of predicted values, are input to the species distribution model. All models are fitted together based only on point-referenced observations, which results in a correct propagation of uncertainty. We use 50 plant species representative of the Dutch flora in natural areas with 8 soil condition predictors taken during field visits in the Netherlands as a case study. We compare the proposed model to the standard approach by studying the difference in associations, predicted maps, and cross-validated accuracy. FINDINGS We find that there are differences between the two approaches in the estimated association between soil conditions and species occurrence (correlation 0.64-0.84), but the predicted maps are quite similar (correlation 0.82-1.00). The differences are more pronounced in the rarer species. The cross-validated accuracy is substantially better for 5 species out of the 50, and the species can also help to predict the soil characteristics. The estimated associations tend to have a smaller magnitude with more certainty. CONCLUSION These findings suggests that the standard model is often sufficient for prediction, but effort should be taken to develop models which take the uncertainty in the independent variables into account for interpretation.
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Affiliation(s)
- Markus Viljanen
- Department of Statistics, Data Science and Modelling, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Lisa Tostrams
- Centre for Environmental Quality, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Niels Schoffelen
- Centre for Environmental Quality, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Jan van de Kassteele
- Department of Statistics, Data Science and Modelling, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Leon Marshall
- Naturalis Biodiversity Center, Leiden, South-Holland, The Netherlands
- Agroecology Lab, Interfaculty School of Bioengineering, Université libre de Bruxelles (ULB), Brussels, Région de Bruxelles-Capitale, Belgium
| | - Merijn Moens
- Naturalis Biodiversity Center, Leiden, South-Holland, The Netherlands
| | - Wouter Beukema
- Reptile, Amphibian & Fish Conservation Netherlands (RAVON), Nijmegen, Gelderland, the Netherlands
| | - Wieger Wamelink
- Wageningen Environmental Research, Wageningen University & Research, Wageningen, Gelderland, The Netherlands
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12
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El-Melegy M, Mamdouh A, Ali S, Badawy M, El-Ghar MA, Alghamdi NS, El-Baz A. Prostate Cancer Diagnosis via Visual Representation of Tabular Data and Deep Transfer Learning. Bioengineering (Basel) 2024; 11:635. [PMID: 39061717 PMCID: PMC11274351 DOI: 10.3390/bioengineering11070635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
Prostate cancer (PC) is a prevalent and potentially fatal form of cancer that affects men globally. However, the existing diagnostic methods, such as biopsies or digital rectal examination (DRE), have limitations in terms of invasiveness, cost, and accuracy. This study proposes a novel machine learning approach for the diagnosis of PC by leveraging clinical biomarkers and personalized questionnaires. In our research, we explore various machine learning methods, including traditional, tree-based, and advanced tabular deep learning methods, to analyze tabular data related to PC. Additionally, we introduce the novel utilization of convolutional neural networks (CNNs) and transfer learning, which have been predominantly applied in image-related tasks, for handling tabular data after being transformed to proper graphical representations via our proposed Tab2Visual modeling framework. Furthermore, we investigate leveraging the prediction accuracy further by constructing ensemble models. An experimental evaluation of our proposed approach demonstrates its effectiveness in achieving superior performance attaining an F1-score of 0.907 and an AUC of 0.911. This offers promising potential for the accurate detection of PC without the reliance on invasive and high-cost procedures.
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Affiliation(s)
- Moumen El-Melegy
- Electrical Engineering Department, Assiut University, Assiut 71516, Egypt; (M.E.-M.); (A.M.); (S.A.)
| | - Ahmed Mamdouh
- Electrical Engineering Department, Assiut University, Assiut 71516, Egypt; (M.E.-M.); (A.M.); (S.A.)
| | - Samia Ali
- Electrical Engineering Department, Assiut University, Assiut 71516, Egypt; (M.E.-M.); (A.M.); (S.A.)
| | - Mohamed Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt; (M.B.); (M.A.E.-G.)
| | - Mohamed Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt; (M.B.); (M.A.E.-G.)
| | - Norah Saleh Alghamdi
- Department of Computer Sciences, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
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13
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Yin R, Chen H, Wang C, Qin C, Tao T, Hao Y, Wu R, Jiang Y, Gui J. Transformer-Based Multilabel Deep Learning Model Is Efficient for Detecting Ankle Lateral and Medial Ligament Injuries on Magnetic Resonance Imaging and Improving Clinicians' Diagnostic Accuracy for Rotational Chronic Ankle Instability. Arthroscopy 2024:S0749-8063(24)00409-2. [PMID: 38876447 DOI: 10.1016/j.arthro.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To develop a deep learning (DL) model that can simultaneously detect lateral and medial collateral ligament injuries of the ankle, aiding in the diagnosis of chronic ankle instability (CAI), and assess its impact on clinicians' diagnostic performance. METHODS DL models were developed and externally validated on retrospectively collected ankle magnetic resonance imaging (MRI) between April 2016 and March 2022 respectively at 3 centers. Included patients had confirmed diagnoses of CAI through arthroscopy, as well as individuals who had undergone MRI and physical examinations that ruled out ligament injuries. DL models were constructed based on a multilabel paradigm. A transformer-based multilabel DL model (AnkleNet) was developed and compared with 4 convolution neural network (CNN) models. Subsequently, a reader study was conducted to evaluate the impact of model assistance on clinicians when diagnosing challenging cases: identifying rotational CAI (RCAI). Diagnostic performance was assessed using area under the receiver operating characteristic curve (AUC). RESULTS Our transformer-based model achieved AUCs of 0.910 and 0.892 for detecting lateral and medial collateral ligament injury, respectively, both of which were significantly higher than those of CNN-based models (all P < .001). In terms of further CAI diagnosis, there was a macro-average AUC of 0.870 and a balanced accuracy of 0.805. The reader study indicated that incorporation with our model significantly enhanced the diagnostic accuracy of clinicians (P = .042), particularly junior clinicians, and led to a reduction in diagnostic variability. The code of the model can be accessed at https://github.com/ChiariRay/AnkleNet. CONCLUSIONS Our transformer-based model was able to detect lateral and medial collateral ligament injuries based on MRI and outperformed CNN-based models, demonstrating a promising performance in diagnosing CAI, especially patients with RCAI. CLINICAL RELEVANCE Developing such an algorithm can improve the diagnostic performance of clinicians, aiding in identifying patients who would benefit from arthroscopy, such as patients with RCAI.
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Affiliation(s)
- Rui Yin
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Clinical Neuroscience, Cambridge University, Cambridge, U.K; School of Computer Science, University of Birmingham, Birmingham, U.K
| | - Changjiang Wang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chaoren Qin
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tianqi Tao
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yunjia Hao
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou, China
| | - Rui Wu
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Orthopedics, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Yiqiu Jiang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianchao Gui
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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14
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Wang Y, Kong X, Bi X, Cui L, Yu H, Wu H. ResDeepSurv: A Survival Model for Deep Neural Networks Based on Residual Blocks and Self-attention Mechanism. Interdiscip Sci 2024; 16:405-417. [PMID: 38489147 DOI: 10.1007/s12539-024-00617-y] [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: 10/09/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
Survival analysis, as a widely used method for analyzing and predicting the timing of event occurrence, plays a crucial role in the medicine field. Medical professionals utilize survival models to gain insight into the effects of patient covariates on the disease, and the correlation with the effectiveness of different treatment strategies. This knowledge is essential for the development of treatment plans and the enhancement of treatment approaches. Conventional survival models, such as the Cox proportional hazards model, require a significant amount of feature engineering or prior knowledge to facilitate personalized modeling. To address these limitations, we propose a novel residual-based self-attention deep neural network for survival modeling, called ResDeepSurv, which combines the benefits of neural networks and the Cox proportional hazards regression model. The model proposed in our study simulates the distribution of survival time and the correlation between covariates and outcomes, but does not impose strict assumptions on the basic distribution of survival data. This approach effectively accounts for both linear and nonlinear risk functions in survival data analysis. The performance of our model in analyzing survival data with various risk functions is on par with or even superior to that of other existing survival analysis methods. Furthermore, we validate the superior performance of our model in comparison to currently existing methods by evaluating multiple publicly available clinical datasets. Through this study, we prove the effectiveness of our proposed model in survival analysis, providing a promising alternative to traditional approaches. The application of deep learning techniques and the ability to capture complex relationships between covariates and survival outcomes without relying on extensive feature engineering make our model a valuable tool for personalized medicine and decision-making in clinical practice.
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Affiliation(s)
- Yuchen Wang
- School of Software, Shandong University, Jinan, 250101, China
| | - Xianchun Kong
- Department of Pediatric Surgery, Heze Municipal Hospital, Heze, 274000, China
| | - Xiao Bi
- School of Mathematics, Shandong University, Jinan, 250100, China
| | - Lizhen Cui
- School of Software, Shandong University, Jinan, 250101, China
| | - Hong Yu
- School of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China
| | - Hao Wu
- School of Software, Shandong University, Jinan, 250101, China.
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Gomes VMR, Pires MC, Delfino Pereira P, Schwarzbold AV, Gomes AGDR, Pessoa BP, Cimini CCR, Rios DRA, Anschau F, Nascimento FJM, Grizende GMS, Vietta GG, Batista JDL, Ruschel KB, Carneiro M, Reis MA, Bicalho MAC, Porto PF, Reis PPD, Araújo SF, Nobre V, Marcolino MS. AB 2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units. Respir Med 2024; 227:107635. [PMID: 38641122 DOI: 10.1016/j.rmed.2024.107635] [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: 09/07/2023] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS This retrospective observational study included consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from September 2021 to July 2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS From 558 patients, median age was 69 years (IQR 58-78), 56.3 % were men, 19.7 % required mechanical ventilation (MV), and 44.8 % died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95 % CI 0.744 to 0.819), good overall performance (Brier score = 0.191) and an excellent calibration (slope = 1.063, intercept = 0.015, p-value = 0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS The AB2CO score is a fast and easy tool to be used upon ICU admission.
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Affiliation(s)
- Virginia Mara Reis Gomes
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Magda Carvalho Pires
- Statistics Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.
| | - Polianna Delfino Pereira
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.
| | | | | | - Bruno Porto Pessoa
- Hospital Julia Kubitschek, R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil.
| | | | - Danyelle Romana Alves Rios
- Hospital São João de Deus, R. Do Cobre, 800, São João de Deus, Brazil; Universidade Federal de São João del-Rei. R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil.
| | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | | | | | | | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Medical School, Federal University of Fronteira Sul, Rod. SC 484 - Km 02, Chapecó, Brazil; Hospital Regional Do Oeste, R. Florianópolis, 1448 E, Chapecó, Brazil.
| | | | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz Do Sul, Brazil.
| | - Marco Aurélio Reis
- Hospital Risoleta Tolentino Neves, R. Das Gabirobas, 01, Belo Horizonte, Brazil.
| | - Maria Aparecida Camargos Bicalho
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Fundação Hospitalar Do Estado de Minas Gerais - FHEMIG. Cidade Administrativa de Minas Gerais, Edifício Gerais - 13° Andar, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil.
| | - Paula Fonseca Porto
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil.
| | | | | | - Vandack Nobre
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Milena Soriano Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil.
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Omiye JA, Ghanzouri I, Lopez I, Wang F, Cabot J, Amal S, Ye J, Lopez NG, Adebayo-Tijani F, Ross EG. Clinical use of polygenic risk scores for detection of peripheral artery disease and cardiovascular events. PLoS One 2024; 19:e0303610. [PMID: 38758931 PMCID: PMC11101066 DOI: 10.1371/journal.pone.0303610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
We have previously shown that polygenic risk scores (PRS) can improve risk stratification of peripheral artery disease (PAD) in a large, retrospective cohort. Here, we evaluate the potential of PRS in improving the detection of PAD and prediction of major adverse cardiovascular and cerebrovascular events (MACCE) and adverse events (AE) in an institutional patient cohort. We created a cohort of 278 patients (52 cases and 226 controls) and fit a PAD-specific PRS based on the weighted sum of risk alleles. We built traditional clinical risk models and machine learning (ML) models using clinical and genetic variables to detect PAD, MACCE, and AE. The models' performances were measured using the area under the curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), and Brier score. We also evaluated the clinical utility of our PAD model using decision curve analysis (DCA). We found a modest, but not statistically significant improvement in the PAD detection model's performance with the inclusion of PRS from 0.902 (95% CI: 0.846-0.957) (clinical variables only) to 0.909 (95% CI: 0.856-0.961) (clinical variables with PRS). The PRS inclusion significantly improved risk re-classification of PAD with an NRI of 0.07 (95% CI: 0.002-0.137), p = 0.04. For our ML model predicting MACCE, the addition of PRS did not significantly improve the AUC, however, NRI analysis demonstrated significant improvement in risk re-classification (p = 2e-05). Decision curve analysis showed higher net benefit of our combined PRS-clinical model across all thresholds of PAD detection. Including PRS to a clinical PAD-risk model was associated with improvement in risk stratification and clinical utility, although we did not see a significant change in AUC. This result underscores the potential clinical utility of incorporating PRS data into clinical risk models for prevalent PAD and the need for use of evaluation metrics that can discern the clinical impact of using new biomarkers in smaller populations.
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Affiliation(s)
- Jesutofunmi A. Omiye
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Ilies Ghanzouri
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Ivan Lopez
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Fudi Wang
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - John Cabot
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Saeed Amal
- Department of Bioengineering, The Roux Institute at Northeastern University, Portland, Maine, United States of America
| | - Jianqin Ye
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Nicolas Gabriel Lopez
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Faatihat Adebayo-Tijani
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Elsie Gyang Ross
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Vascular Surgery, Department of Surgery, UC San Diego School of Medicine, La Jolla, California, United States of America
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MacCarthy G, Pazoki R. Using Machine Learning to Evaluate the Value of Genetic Liabilities in the Classification of Hypertension within the UK Biobank. J Clin Med 2024; 13:2955. [PMID: 38792496 PMCID: PMC11122671 DOI: 10.3390/jcm13102955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background and Objective: Hypertension increases the risk of cardiovascular diseases (CVD) such as stroke, heart attack, heart failure, and kidney disease, contributing to global disease burden and premature mortality. Previous studies have utilized statistical and machine learning techniques to develop hypertension prediction models. Only a few have included genetic liabilities and evaluated their predictive values. This study aimed to develop an effective hypertension classification model and investigate the potential influence of genetic liability for multiple risk factors linked to CVD on hypertension risk using the random forest and the neural network. Materials and Methods: The study involved 244,718 European participants, who were divided into training and testing sets. Genetic liabilities were constructed using genetic variants associated with CVD risk factors obtained from genome-wide association studies (GWAS). Various combinations of machine learning models before and after feature selection were tested to develop the best classification model. The models were evaluated using area under the curve (AUC), calibration, and net reclassification improvement in the testing set. Results: The models without genetic liabilities achieved AUCs of 0.70 and 0.72 using the random forest and the neural network methods, respectively. Adding genetic liabilities improved the AUC for the random forest but not for the neural network. The best classification model was achieved when feature selection and classification were performed using random forest (AUC = 0.71, Spiegelhalter z score = 0.10, p-value = 0.92, calibration slope = 0.99). This model included genetic liabilities for total cholesterol and low-density lipoprotein (LDL). Conclusions: The study highlighted that incorporating genetic liabilities for lipids in a machine learning model may provide incremental value for hypertension classification beyond baseline characteristics.
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Affiliation(s)
- Gideon MacCarthy
- Cardiovascular and Metabolic Research Group, Division of Biomedical Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London UB8 3PH, UK
| | - Raha Pazoki
- Cardiovascular and Metabolic Research Group, Division of Biomedical Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London UB8 3PH, UK
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, St Mary’s Campus, Norfolk Place, Imperial College London, London W2 1PG, UK
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McCurdy JD, Munir J, Parlow S, Reid J, Yanofsky R, Alenezi T, Meserve J, Becker B, Lahijanian Z, Eddin AH, Mallick R, Ramsay T, Rosenfeld G, Bessissow A, Bessissow T, Jairath V, Singh S, Bruining DH, Macdonald B. Development of an MRI-Based Prediction Model for Anti-TNF Treatment Failure in Perianal Crohn's Disease: A Multicenter Study. Clin Gastroenterol Hepatol 2024; 22:1058-1066.e2. [PMID: 38122958 DOI: 10.1016/j.cgh.2023.12.006] [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: 09/02/2023] [Revised: 11/10/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND & AIMS Clinical and radiologic variables associated with perianal fistula (PAF) outcomes are poorly understood. We developed prediction models for anti-tumor necrosis factor (TNF) treatment failure in patients with Crohn's disease-related PAF. METHODS In a multicenter retrospective study between 2005 and 2022 we included biologic-naive adults (>17 years) who initiated their first anti-TNF therapy for PAF after pelvic magnetic resonance imaging (MRI). Pretreatment MRI studies were prospectively reread centrally by blinded radiologists. We developed and internally validated a prediction model based on clinical and radiologic parameters to predict the likelihood of anti-TNF treatment failure, clinically, at 6 months. We compared our model and a simplified version of MRI parameters alone with existing imaging-based PAF activity indices (MAGNIFI-CD and modified Van Assche MRI scores) by De Long statistical test. RESULTS We included 221 patients: 32 ± 14 years, 60% males, 76% complex fistulas; 68% treated with infliximab and 32% treated with adalimumab. Treatment failure occurred in 102 (46%) patients. Our prediction model included age at PAF diagnosis, time to initiate anti-TNF treatment, and smoking and 8 MRI characteristics (supra/extrasphincteric anatomy, fistula length >4.3 cm, primary tracts >1, secondary tracts >1, external openings >1, tract hyperintensity on T1-weighted imaging, horseshoe anatomy, and collections >1.3 cm). Our full and simplified MRI models had fair discriminatory capacity for anti-TNF treatment failure (concordance statistic, 0.67 and 0.65, respectively) and outperformed MAGNIFI-CD (P = .002 and < .0005) and modified Van Assche MRI scores (P < .0001 and < .0001), respectively. CONCLUSIONS Our risk prediction models consisting of clinical and/or radiologic variables accurately predict treatment failure in patients with PAF.
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Affiliation(s)
- Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Javeria Munir
- Division of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Simon Parlow
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacqueline Reid
- Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - Russell Yanofsky
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Talal Alenezi
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Joseph Meserve
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Brenda Becker
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Zubin Lahijanian
- Division of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada
| | - Anas Hussam Eddin
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Greg Rosenfeld
- Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - Ali Bessissow
- Division of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Siddharth Singh
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Blair Macdonald
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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Zeng J, Song D, Li K, Cao F, Zheng Y. Deep learning model for predicting postoperative survival of patients with gastric cancer. Front Oncol 2024; 14:1329983. [PMID: 38628668 PMCID: PMC11018873 DOI: 10.3389/fonc.2024.1329983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background Prognostic prediction for surgical treatment of gastric cancer remains valuable in clinical practice. This study aimed to develop survival models for postoperative gastric cancer patients. Methods Eleven thousand seventy-five patients from the Surveillance, Epidemiology, and End Results (SEER) database were included, and 122 patients from the Chinese database were used for external validation. The training cohort was created to create three separate models, including Cox regression, RSF, and DeepSurv, using data from the SEER database split into training and test cohorts with a 7:3 ratio. Test cohort was used to evaluate model performance using c-index, Brier scores, calibration, and the area under the curve (AUC). The new risk stratification based on the best model will be compared with the AJCC stage on the test and Chinese cohorts using decision curve analysis (DCA), the net reclassification index (NRI), and integrated discrimination improvement (IDI). Results It was discovered that the DeepSurv model predicted postoperative gastric cancer patients' overall survival (OS) with a c-index of 0.787; the area under the curve reached 0.781, 0.798, 0.868 at 1-, 3- and 5- years, respectively; the Brier score was below 0.25 at different time points; showing an advantage over the Cox and RSF models. The results are also validated in the China cohort. The calibration plots demonstrated good agreement between the DeepSurv model's forecast and actual results. The NRI values (test cohort: 0.399, 0.288, 0.267 for 1-, 3- and 5-year OS prediction; China cohort:0.399, 0.288 for 1- and 3-year OS prediction) and IDI (test cohort: 0.188, 0.169, 0.157 for 1-, 3- and 5-year OS prediction; China cohort: 0.189, 0.169 for 1- and 3-year OS prediction) indicated that the risk score stratification performed significantly better than the AJCC staging alone (P < 0.05). DCA showed that the risk score stratification was clinically useful and had better discriminative ability than the AJCC staging. Finally, an interactive native web-based prediction tool was constructed for the survival prediction of patients with postoperative gastric cancer. Conclusion In this study, a high-performance prediction model for the postoperative prognosis of gastric cancer was developed using DeepSurv, which offers essential benefits for risk stratification and prognosis prediction for each patient.
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Affiliation(s)
| | | | | | | | - Yongbin Zheng
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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20
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Douillet D, Riou J, Morin F, Mahieu R, Chauvin A, Gennai S, Ferrant L, Lopez R, Sebbane M, Plantefeve G, Brice C, Cayeux C, Savary D, Moumneh T, Penaloza A, Roy PM. Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score. Emerg Med J 2024; 41:218-225. [PMID: 38365436 DOI: 10.1136/emermed-2022-212631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. METHODS A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort. RESULTS There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were <2 and >3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of <2 qualified 73% of patients as low risk with a sensitivity of 0.77 (0.55-0.92) and a negative predictive value of 0.99 (0.99-1.00). CONCLUSION The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.
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Affiliation(s)
- Delphine Douillet
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
| | - Jérémie Riou
- Micro et Nano médecines Translationnelles, MINT, UNIV Angers, UMR INSERM 1066, UMR CNRS 6021, CHU Angers, Angers, France
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Université Angers Faculté des Sciences, Angers, France
| | - François Morin
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
| | - Rafaël Mahieu
- Department of Infectious Disease, Angers University Hospital; University of Angers, CHU Angers, Angers, France
- CRCINA, Inserm U1232, University of Nantes-Angers, Universite Angers Faculte Des Sciences, Angers, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, University Hospital Centre Reims, Reims, France
- UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - Lionel Ferrant
- Emergency Department, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Raphaëlle Lopez
- Emergency Department, Sart Tilman University Hospital, Centre hospitalier universitaire de Liège, Liege, Belgium
| | - Mustapha Sebbane
- Emergency Department, Montpellier University Hospital, Montpellier, France
| | | | - Christian Brice
- Emergency Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Coralie Cayeux
- Emergency Department, Centre Hospitalier de Remiremont, Remiremont, France
| | - Dominique Savary
- Department of Emergency Medicine, University of Angers, ANGERS, France
- Inserm IRSET UMR_S1085, I, EHESP, Angers, France
| | | | - Andrea Penaloza
- Emergency, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pierre Marie Roy
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
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Kornas K, Tait C, Negatu E, Rosella LC. External validation and application of the Diabetes Population Risk Tool (DPoRT) for prediction of type 2 diabetes onset in the US population. BMJ Open Diabetes Res Care 2024; 12:e003905. [PMID: 38453237 PMCID: PMC10921488 DOI: 10.1136/bmjdrc-2023-003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Characterizing diabetes risk in the population is important for population health assessment and diabetes prevention planning. We aimed to externally validate an existing 10-year population risk model for type 2 diabetes in the USA and model the population benefit of diabetes prevention approaches using population survey data. RESEARCH DESIGN AND METHODS The Diabetes Population Risk Tool (DPoRT), originally derived and validated in Canada, was applied to an external validation cohort of 23 477 adults from the 2009 National Health Interview Survey (NHIS). We assessed predictive performance for discrimination (C-statistic) and calibration plots against observed incident diabetes cases identified from the NHIS 2009-2018 cycles. We applied DPoRT to the 2018 NHIS cohort (n=21 187) to generate 10-year risk prediction estimates and characterize the preventive benefit of three diabetes prevention scenarios: (1) community-wide strategy; (2) high-risk strategy and (3) combined approach. RESULTS DPoRT demonstrated good discrimination (C-statistic=0.778 (males); 0.787 (females)) and good calibration across the range of risk. We predicted a baseline risk of 10.2% and 21 076 000 new cases of diabetes in the USA from 2018 to 2028. The community-wide strategy and high-risk strategy estimated diabetes risk reductions of 0.2% and 0.3%, respectively. The combined approach estimated a 0.4% risk reduction and 843 000 diabetes cases averted in 10 years. CONCLUSIONS DPoRT has transportability for predicting population-level diabetes risk in the USA using routinely collected survey data. We demonstrate the model's applicability for population health assessment and diabetes prevention planning. Our modeling predicted that the combination of community-wide and targeted prevention approaches for those at highest risk are needed to reduce diabetes burden in the USA.
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Affiliation(s)
- Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ednah Negatu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Temerty Faculty of Medicine, Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
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de Graaf D, Araújo R, Derksen M, Zwinderman K, de Vries NM, IntHout J, Bloem BR. The sound of Parkinson's disease: A model of audible bradykinesia. Parkinsonism Relat Disord 2024; 120:106003. [PMID: 38219529 DOI: 10.1016/j.parkreldis.2024.106003] [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: 11/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Evaluation of bradykinesia is based on five motor tasks from the MDS-UPDRS. Visually scoring these motor tasks is subjective, resulting in significant interrater variability. Recent observations suggest that it may be easier to hear the characteristic features of bradykinesia, such as the decrement in sound intensity or force of repetitive movements. The objective is to evaluate whether audio signals derived during four MDS-UPDRS tasks can be used to detect and grade bradykinesia, using two machine learning models. METHODS 54 patients with Parkinson's disease and 28 healthy controls were filmed while executing the bradykinesia motor tasks. Several features were extracted from the audio signal, including number of taps, speed, sound intensity, decrement and freezes. For each motor task, two supervised machine learning models were trained, Logistic Regression (LR) and Support Vector Machine (SVM). RESULTS Both classifiers were able to separate patients from controls reasonably well for the leg agility task, area under the receiver operating characteristic curve (AUC): 0.92 (95%CI: 0.78-0.99) for LR and 0.93 (0.81-1.00) for SVM. Also, models were able to differentiate less severe bradykinesia from severe bradykinesia, particularly for the pronation-supination motor task, with AUC: 0.90 (0.62-1.00) for LR and 0.82 (0.45-0.97) for SVM. CONCLUSION This audio-based approach discriminates PD from healthy controls with moderate-high accuracy and separated individuals with less severe bradykinesia from those with severe bradykinesia. Sound analysis may contribute to the identification and monitoring of bradykinesia.
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Affiliation(s)
- Debbie de Graaf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Koos Zwinderman
- Academic Medical Center, Department of Cardiology, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Nienke M de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Department for Health Evidence Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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Aygun U, Yagin FH, Yagin B, Yasar S, Colak C, Ozkan AS, Ardigò LP. Assessment of Sepsis Risk at Admission to the Emergency Department: Clinical Interpretable Prediction Model. Diagnostics (Basel) 2024; 14:457. [PMID: 38472930 DOI: 10.3390/diagnostics14050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
This study aims to develop an interpretable prediction model based on explainable artificial intelligence to predict bacterial sepsis and discover important biomarkers. A total of 1572 adult patients, 560 of whom were sepsis positive and 1012 of whom were negative, who were admitted to the emergency department with suspicion of sepsis, were examined. We investigated the performance characteristics of sepsis biomarkers alone and in combination for confirmed sepsis diagnosis using Sepsis-3 criteria. Three different tree-based algorithms-Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Adaptive Boosting (AdaBoost)-were used for sepsis prediction, and after examining comprehensive performance metrics, descriptions of the optimal model were obtained with the SHAP method. The XGBoost model achieved accuracy of 0.898 (0.868-0.929) and area under the ROC curve (AUC) of 0.940 (0.898-0.980) with a 95% confidence interval. The five biomarkers for predicting sepsis were age, respiratory rate, oxygen saturation, procalcitonin, and positive blood culture. SHAP results revealed that older age, higher respiratory rate, procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, plaque, leukocyte particle concentration, as well as lower oxygen saturation, systolic blood pressure, and hemoglobin levels increased the risk of sepsis. As a result, the Explainable Artificial Intelligence (XAI)-based prediction model can guide clinicians in the early diagnosis and treatment of sepsis, providing more effective sepsis management and potentially reducing mortality rates and medical costs.
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Affiliation(s)
- Umran Aygun
- Department of Anesthesiology and Reanimation, Malatya Yesilyurt Hasan Calık State Hospital, Malatya 44929, Turkey
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Burak Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Seyma Yasar
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Ahmet Selim Ozkan
- Department of Anesthesiology and Reanimation, Malatya Turgut Ozal University School of Medicine, Malatya 44210, Turkey
| | - Luca Paolo Ardigò
- Department of Teacher Education, NLA University College, 0166 Oslo, Norway
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Rahmatinejad Z, Dehghani T, Hoseini B, Rahmatinejad F, Lotfata A, Reihani H, Eslami S. A comparative study of explainable ensemble learning and logistic regression for predicting in-hospital mortality in the emergency department. Sci Rep 2024; 14:3406. [PMID: 38337000 PMCID: PMC10858239 DOI: 10.1038/s41598-024-54038-4] [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: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
This study addresses the challenges associated with emergency department (ED) overcrowding and emphasizes the need for efficient risk stratification tools to identify high-risk patients for early intervention. While several scoring systems, often based on logistic regression (LR) models, have been proposed to indicate patient illness severity, this study aims to compare the predictive performance of ensemble learning (EL) models with LR for in-hospital mortality in the ED. A cross-sectional single-center study was conducted at the ED of Imam Reza Hospital in northeast Iran from March 2016 to March 2017. The study included adult patients with one to three levels of emergency severity index. EL models using Bagging, AdaBoost, random forests (RF), Stacking and extreme gradient boosting (XGB) algorithms, along with an LR model, were constructed. The training and validation visits from the ED were randomly divided into 80% and 20%, respectively. After training the proposed models using tenfold cross-validation, their predictive performance was evaluated. Model performance was compared using the Brier score (BS), The area under the receiver operating characteristics curve (AUROC), The area and precision-recall curve (AUCPR), Hosmer-Lemeshow (H-L) goodness-of-fit test, precision, sensitivity, accuracy, F1-score, and Matthews correlation coefficient (MCC). The study included 2025 unique patients admitted to the hospital's ED, with a total percentage of hospital deaths at approximately 19%. In the training group and the validation group, 274 of 1476 (18.6%) and 152 of 728 (20.8%) patients died during hospitalization, respectively. According to the evaluation of the presented framework, EL models, particularly Bagging, predicted in-hospital mortality with the highest AUROC (0.839, CI (0.802-0.875)) and AUCPR = 0.64 comparable in terms of discrimination power with LR (AUROC (0.826, CI (0.787-0.864)) and AUCPR = 0.61). XGB achieved the highest precision (0.83), sensitivity (0.831), accuracy (0.842), F1-score (0.833), and the highest MCC (0.48). Additionally, the most accurate models in the unbalanced dataset belonged to RF with the lowest BS (0.128). Although all studied models overestimate mortality risk and have insufficient calibration (P > 0.05), stacking demonstrated relatively good agreement between predicted and actual mortality. EL models are not superior to LR in predicting in-hospital mortality in the ED. Both EL and LR models can be considered as screening tools to identify patients at risk of mortality.
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Affiliation(s)
- Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Toktam Dehghani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Toos Institute of Higher Education, Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aynaz Lotfata
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
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Schönnagel L, Caffard T, Vu-Han TL, Zhu J, Nathoo I, Finos K, Camino-Willhuber G, Tani S, Guven AE, Haffer H, Muellner M, Arzani A, Chiapparelli E, Amoroso K, Shue J, Duculan R, Pumberger M, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Predicting postoperative outcomes in lumbar spinal fusion: development of a machine learning model. Spine J 2024; 24:239-249. [PMID: 37866485 DOI: 10.1016/j.spinee.2023.09.029] [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: 06/08/2023] [Revised: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a prevalent spinal disorder, often requiring surgical intervention. Accurately predicting surgical outcomes is crucial to guide clinical decision-making, but this is challenging due to the multifactorial nature of postoperative results. Traditional risk assessment tools have limitations, and with the advent of machine learning, there is potential to enhance the precision and comprehensiveness of preoperative evaluations. PURPOSE We aimed to develop a machine-learning algorithm to predict surgical outcomes in patients with degenerative lumbar spondylolisthesis (DLS) undergoing spinal fusion surgery, only using preoperative data. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients with DLS undergoing lumbar spinal fusion surgery. OUTCOME MEASURES This study aimed to predict the occurrence of lower back pain (LBP) ≥4 on the numeric analogue scale (NAS) 2 years after surgery. LBP was evaluated as the average pain patients experienced at rest in the week before questioning. NAS ranges from 0 to 10, 0 representing no pain and 10 representing the worst pain imaginable. METHODS We conducted a retrospective analysis of prospectively enrolled patients who underwent spinal fusion surgery for degenerative lumbar spondylolistheses at our institution in the United States between January 2016 and December 2018. The initial patient characteristics to be included in the training of the model were chosen by clinical expertise and through a literature review and included demographic characteristics, comorbidities, and radiologic features. The data was split into a training and validation datasets using a 60/40 split. Four different machine learning models were trained, including the modern XGBoost model, logistic regression, random-forest, and support vector machine (SVM). The models were evaluated according to the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. An AUC of 0.7 to 0.8 was considered fair, 0.8 to 0.9 good, and ≥ 0.9 excellent. Additionally, a calibration plot and the Brier score were calculated for each model. RESULTS A total of 135 patients (66% female) were included. A total of 38 (28%) patients reported LBP ≥ 4 after 2 years, representing the positive class. The XGBoost model demonstrated the best performance in the validation set with an AUC of 0.81 (95% CI 0.67-0.95). The other machine learning models performed significantly worse: with an AUC of 0.52 (95% CI 0.37-0.68) for the SVM, 0.56 (95% CI 0.37-0.76) for the logistic regression and an AUC of 0.56 (95% CI 0.37-0.78) for the random forest. In the XGBoost model age, composition of the erector spinae, and severity of lumbar spinal stenosis as were identified as the most important features. CONCLUSIONS This study represents a novel approach to predicting surgical outcomes in spinal fusion patients. The XGBoost demonstrated a better performance compared with classical models and highlighted the potential contributions of age and paraspinal musculature atrophy as significant factors. These findings have important implications for enhancing patient care through the identification of high-risk individuals and modifiable risk factors. As the incorporation of machine learning algorithms into clinical decision-making continues to gain traction in research and clinical practice, our insights reinforce this trajectory by showcasing the potential of these techniques in forecasting surgical results.
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Affiliation(s)
- Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Tu-Lan Vu-Han
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Isaac Nathoo
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Kyle Finos
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Gaston Camino-Willhuber
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Roland Duculan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Timo Zippelius
- Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Carol A Mancuso
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Zhang H, Zeng T, Zhang J, Zheng J, Min J, Peng M, Liu G, Zhong X, Wang Y, Qiu K, Tian S, Liu X, Huang H, Surmach M, Wang P, Hu X, Chen L. Development and validation of machine learning-augmented algorithm for insulin sensitivity assessment in the community and primary care settings: a population-based study in China. Front Endocrinol (Lausanne) 2024; 15:1292346. [PMID: 38332892 PMCID: PMC10850228 DOI: 10.3389/fendo.2024.1292346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Objective Insulin plays a central role in the regulation of energy and glucose homeostasis, and insulin resistance (IR) is widely considered as the "common soil" of a cluster of cardiometabolic disorders. Assessment of insulin sensitivity is very important in preventing and treating IR-related disease. This study aims to develop and validate machine learning (ML)-augmented algorithms for insulin sensitivity assessment in the community and primary care settings. Methods We analyzed the data of 9358 participants over 40 years old who participated in the population-based cohort of the Hubei center of the REACTION study (Risk Evaluation of Cancers in Chinese Diabetic Individuals). Three non-ensemble algorithms and four ensemble algorithms were used to develop the models with 70 non-laboratory variables for the community and 87 (70 non-laboratory and 17 laboratory) variables for the primary care settings to screen the classifier of the state-of-the-art. The models with the best performance were further streamlined using top-ranked 5, 8, 10, 13, 15, and 20 features. Performances of these ML models were evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPR), and the Brier score. The Shapley additive explanation (SHAP) analysis was employed to evaluate the importance of features and interpret the models. Results The LightGBM models developed for the community (AUROC 0.794, AUPR 0.575, Brier score 0.145) and primary care settings (AUROC 0.867, AUPR 0.705, Brier score 0.119) achieved higher performance than the models constructed by the other six algorithms. The streamlined LightGBM models for the community (AUROC 0.791, AUPR 0.563, Brier score 0.146) and primary care settings (AUROC 0.863, AUPR 0.692, Brier score 0.124) using the 20 top-ranked variables also showed excellent performance. SHAP analysis indicated that the top-ranked features included fasting plasma glucose (FPG), waist circumference (WC), body mass index (BMI), triglycerides (TG), gender, waist-to-height ratio (WHtR), the number of daughters born, resting pulse rate (RPR), etc. Conclusion The ML models using the LightGBM algorithm are efficient to predict insulin sensitivity in the community and primary care settings accurately and might potentially become an efficient and practical tool for insulin sensitivity assessment in these settings.
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Affiliation(s)
- Hao Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Tianshu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Jiaoyue Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Jie Min
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Miaomiao Peng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Geng Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Xueyu Zhong
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Ying Wang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Kangli Qiu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Shenghua Tian
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Xiaohuan Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Hantao Huang
- Department of Emergency Medicine, Yichang Yiling Hospital, Yichang, China
| | - Marina Surmach
- Department of Public Health and Health Services, Grodno State Medical University, Grodno, Belarus
| | - Ping Wang
- Precision Health Program, Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Xiang Hu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
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Lee JH, Shin J, Min JH, Jeong WK, Kim H, Choi SY, Lee J, Hong S, Kim K. Preoperative prediction of early recurrence in resectable pancreatic cancer integrating clinical, radiologic, and CT radiomics features. Cancer Imaging 2024; 24:6. [PMID: 38191489 PMCID: PMC10775464 DOI: 10.1186/s40644-024-00653-3] [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: 07/26/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES To use clinical, radiographic, and CT radiomics features to develop and validate a preoperative prediction model for the early recurrence of pancreatic cancer. METHODS We retrospectively analyzed 190 patients (150 and 40 in the development and test cohort from different centers) with pancreatic cancer who underwent pancreatectomy between January 2018 and June 2021. Radiomics, clinical-radiologic (CR), and clinical-radiologic-radiomics (CRR) models were developed for the prediction of recurrence within 12 months after surgery. Performance was evaluated using the area under the curve (AUC), Brier score, sensitivity, and specificity. RESULTS Early recurrence occurred in 36.7% and 42.5% of the development and test cohorts, respectively (P = 0.62). The features for the CR model included carbohydrate antigen 19-9 > 500 U/mL (odds ratio [OR], 3.60; P = 0.01), abutment to the portal and/or superior mesenteric vein (OR, 2.54; P = 0.054), and adjacent organ invasion (OR, 2.91; P = 0.03). The CRR model demonstrated significantly higher AUCs than the radiomics model in the internal (0.77 vs. 0.73; P = 0.048) and external (0.83 vs. 0.69; P = 0.038) validations. Although we found no significant difference between AUCs of the CR and CRR models (0.83 vs. 0.76; P = 0.17), CRR models showed more balanced sensitivity and specificity (0.65 and 0.87) than CR model (0.41 and 0.91) in the test cohort. CONCLUSIONS The CRR model outperformed the radiomics and CR models in predicting the early recurrence of pancreatic cancer, providing valuable information for risk stratification and treatment guidance.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Honsoul Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jisun Lee
- Department of Radiology, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sungjun Hong
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Demircioğlu A. The effect of feature normalization methods in radiomics. Insights Imaging 2024; 15:2. [PMID: 38185786 PMCID: PMC10772134 DOI: 10.1186/s13244-023-01575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVES In radiomics, different feature normalization methods, such as z-Score or Min-Max, are currently utilized, but their specific impact on the model is unclear. We aimed to measure their effect on the predictive performance and the feature selection. METHODS We employed fifteen publicly available radiomics datasets to compare seven normalization methods. Using four feature selection and classifier methods, we used cross-validation to measure the area under the curve (AUC) of the resulting models, the agreement of selected features, and the model calibration. In addition, we assessed whether normalization before cross-validation introduces bias. RESULTS On average, the difference between the normalization methods was relatively small, with a gain of at most + 0.012 in AUC when comparing the z-Score (mean AUC: 0.707 ± 0.102) to no normalization (mean AUC: 0.719 ± 0.107). However, on some datasets, the difference reached + 0.051. The z-Score performed best, while the tanh transformation showed the worst performance and even decreased the overall predictive performance. While quantile transformation performed, on average, slightly worse than the z-Score, it outperformed all other methods on one out of three datasets. The agreement between the features selected by different normalization methods was only mild, reaching at most 62%. Applying the normalization before cross-validation did not introduce significant bias. CONCLUSION The choice of the feature normalization method influenced the predictive performance but depended strongly on the dataset. It strongly impacted the set of selected features. CRITICAL RELEVANCE STATEMENT Feature normalization plays a crucial role in the preprocessing and influences the predictive performance and the selected features, complicating feature interpretation. KEY POINTS • The impact of feature normalization methods on radiomic models was measured. • Normalization methods performed similarly on average, but differed more strongly on some datasets. • Different methods led to different sets of selected features, impeding feature interpretation. • Model calibration was not largely affected by the normalization method.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
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Lombardi A, Arezzo F, Di Sciascio E, Ardito C, Mongelli M, Di Lillo N, Fascilla FD, Silvestris E, Kardhashi A, Putino C, Cazzolla A, Loizzi V, Cazzato G, Cormio G, Di Noia T. A human-interpretable machine learning pipeline based on ultrasound to support leiomyosarcoma diagnosis. Artif Intell Med 2023; 146:102697. [PMID: 38042596 DOI: 10.1016/j.artmed.2023.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/08/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
The preoperative evaluation of myometrial tumors is essential to avoid delayed treatment and to establish the appropriate surgical approach. Specifically, the differential diagnosis of leiomyosarcoma (LMS) is particularly challenging due to the overlapping of clinical, laboratory and ultrasound features between fibroids and LMS. In this work, we present a human-interpretable machine learning (ML) pipeline to support the preoperative differential diagnosis of LMS from leiomyomas, based on both clinical data and gynecological ultrasound assessment of 68 patients (8 with LMS diagnosis). The pipeline provides the following novel contributions: (i) end-users have been involved both in the definition of the ML tasks and in the evaluation of the overall approach; (ii) clinical specialists get a full understanding of both the decision-making mechanisms of the ML algorithms and the impact of the features on each automatic decision. Moreover, the proposed pipeline addresses some of the problems concerning both the imbalance of the two classes by analyzing and selecting the best combination of the synthetic oversampling strategy of the minority class and the classification algorithm among different choices, and the explainability of the features at global and local levels. The results show very high performance of the best strategy (AUC = 0.99, F1 = 0.87) and the strong and stable impact of two ultrasound-based features (i.e., tumor borders and consistency of the lesions). Furthermore, the SHAP algorithm was exploited to quantify the impact of the features at the local level and a specific module was developed to provide a template-based natural language (NL) translation of the explanations for enhancing their interpretability and fostering the use of ML in the clinical setting.
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Affiliation(s)
- Angela Lombardi
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy.
| | - Francesca Arezzo
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Eugenio Di Sciascio
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
| | - Carmelo Ardito
- Department of Engineering, LUM "Giuseppe Degennaro" University, Casamassima, Bari, Italy
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Di Lillo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Erica Silvestris
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anila Kardhashi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Carmela Putino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ambrogio Cazzolla
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
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Chen TLW, Buddhiraju A, Seo HH, Shimizu MR, Bacevich BM, Kwon YM. Can machine learning models predict prolonged length of hospital stay following primary total knee arthroplasty based on a national patient cohort data? Arch Orthop Trauma Surg 2023; 143:7185-7193. [PMID: 37592158 DOI: 10.1007/s00402-023-05013-7] [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: 06/06/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The total length of stay (LOS) is one of the biggest determinators of overall care costs associated with total knee arthroplasty (TKA). An accurate prediction of LOS could aid in optimizing discharge strategy for patients in need and diminishing healthcare expenditure. The aim of this study was to predict LOS following TKA using machine learning models developed on a national-scale patient cohort. METHODS The ACS-NSQIP database was queried to acquire 267,966 TKA cases from 2013 to 2020. Four machine learning models-artificial neural network (ANN), random forest, histogram-based gradient boosting, and k-nearest neighbor were trained and tested on the dataset for the prediction of prolonged LOS (LOS exceeded the 75th of all values in the cohort). The model performance was assessed by discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and clinical utility. RESULTS ANN delivered the best performance among the four models. ANN distinguished prolonged LOS in the study cohort with an AUC of 0.71 and accurately predicted the probability of prolonged LOS for individual patients (calibration slope: 0.82; calibration intercept: 0.03; Brier score: 0.089). All models demonstrated clinical utility by generating positive net benefits in decision curve analyses. Operation time, pre-operative transfusion, pre-operative laboratory tests (hematocrit, platelet count, and white blood cell count), and BMI were the strongest predictors of prolonged LOS. CONCLUSION ANN demonstrated modest discrimination capacity and excellent performance in calibration and clinical utility for the prediction of prolonged LOS following TKA. Clinical application of the machine learning models has the potential to improve care coordination and discharge planning for patients at high risk of extended hospitalization after surgery. Incorporating more relevant patient factors may further increase the models' prediction strength.
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Affiliation(s)
- Tony Lin-Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Hojoon Seo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle Riyo Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Blake M Bacevich
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Lim SJ, Jeon ET, Baek N, Chung YH, Kim SY, Song I, Rah YC, Oh KH, Choi J. Prediction of Hearing Prognosis After Intact Canal Wall Mastoidectomy With Tympanoplasty Using Artificial Intelligence. Otolaryngol Head Neck Surg 2023; 169:1597-1605. [PMID: 37538032 DOI: 10.1002/ohn.472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To evaluate the performance of a machine learning model and the effects of major prognostic factors on hearing outcomes following intact canal wall (ICW) mastoidectomy with tympanoplasty. STUDY DESIGN Retrospective cross-sectional study. SETTING Tertiary hospital. METHODS A total of 484 patients with chronic otitis media who underwent ICW tympanomastoidectomy between January 2007 and December 2020 were included in this study. Successful hearing outcomes were defined by a postoperative air-bone gap (ABG) of ≤20 dB and preoperative air conduction (AC)-postoperative AC value of ≥15 dB according to the Korean Otological Society guidelines for outcome reporting after chronic otitis media surgery. The light gradient boosting machine (LightGBM) and multilayer perceptron (MLP) models were tested as artificial intelligence models and compared using logistic regression. The main outcome assessed was the successful hearing outcome after surgery, measured using the area under the receiver operating characteristic curve (AUROC). RESULTS In the analysis using the postoperative ABG criterion, the LightGBM exhibited a significantly higher AUROC compared to those of the baseline model (mean, 0.811). According to the difference between preoperative and postoperative AC, the MLP showed a significantly higher AUROC than those of the baseline model (mean, 0.795). CONCLUSION This study analyzed multiple factors that could affect the hearing outcome using different artificial intelligence models and found that preoperative hearing status was the most important factor. Our findings provide additional information regarding postoperative hearing for clinicians.
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Affiliation(s)
- Sung Jin Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Eun-Tae Jeon
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Namyoung Baek
- Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Young Han Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sang Yeop Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Kyoung Ho Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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Yu Q, Li Z, Yang C, Zhang L, Xing M, Li W. Predicting functional dependency using machine learning among a middle-aged and older Chinese population. Arch Gerontol Geriatr 2023; 115:105124. [PMID: 37454417 DOI: 10.1016/j.archger.2023.105124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To develop prediction models for assessing functional dependency in a middle-aged and older Chinese population. METHOD Adults ≥45 years old from the China Health and Retirement Longitudinal Study (CHARLS) and without functional dependency at baseline were included. Functional dependency was defined as needing any help in any basic activities of daily living (ADL) or instrumental activities of daily living (IADL). The outcomes were overall functional dependency, ADL and IADL dependency. Stacked ensemble models were constructed based on five selected machine learning models. Models were trained and tested in the 2011-2015 cohort, and were externally validated in the 2015-2018 cohort. SHapley Additive exPlanations (SHAP) was utilized to quantify the significance of predictors. RESULT In the training cohort, a total of 6,297 participants were included at baseline, 1,893 developed functional dependency during the follow-up period. The stacked ensemble model achieved the best performance in terms of discrimination ability for predicting overall functional dependency, ADL and IADL dependency, with AUCs of 0.750, 0.690 and 0.748, respectively; in external validation cohort, the corresponding AUCs were 0.725, 0.719 and 0.727, respectively. A compact model was further developed and maintained similar predictive performance. CONCLUSION The stacked ensemble approach can serve as a useful tool for identifying the risk of functional dependency in a large Chinese population. For ADL dependency, arthritis, age, self-report health, and waist circumference were identified as highly significant predictors. Conversely, cognitive function, age, living in rural areas, and performance in chair stand test emerged as highly ranked predictors for IADL dependency.
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Affiliation(s)
- Qi Yu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zihan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chenyu Yang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingzhi Zhang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Muqi Xing
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenyuan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Li Y, Liu X, Kang L, Li J. Validation and Comparison of Four Mortality Prediction Models in a Geriatric Ward in China. Clin Interv Aging 2023; 18:2009-2019. [PMID: 38053653 PMCID: PMC10695131 DOI: 10.2147/cia.s429769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose The efficacy of mortality risk prediction models among older patients in China remains uncertain. We aimed to validate and compare the performances of the Walter Index, Geriatric Prognostic Index (GPI), Charlson Comorbidity Index (CCI), and FRAIL Scale in predicting 1-year all-cause mortality post-discharge in geriatric inpatients in China. Patients and Methods This study was conducted at a geriatric ward of a tertiary Hospital in Beijing, including patients aged 70 years or older with a documented comprehensive geriatric assessment, discharged between January 1, 2016, and December 31, 2021. Patients with a hospital stay ≤24 h or >60 days were excluded. All-cause mortality data within one year of discharge were collected from medical files and telephone interviews between August 2022 and February 2023. Multiple imputation, Logistic regression analysis, Brier scores, C-statistics, Hosmer-Lemeshow goodness-of-fit-test, and calibration plots were employed for statistical analysis. Results We included 832 patients with a median (interquartile range) age of 77 (74-82) years. One-hundred patients (12.0%) died within one year. After adjusting for covariates-marital status, social support, cigarette use, length of stay, number of medications, hemoglobin levels, handgrip strength, and Short Physical Performance Battery-CCI scores of 3-4 and >4, and increased Walter Index, GPI, and FRAIL Scale scores were significantly associated with 1-year mortality risk. The Brier scores varied from 0.07 (Walter Index) to 0.10 (FRAIL Scale). The C-statistic ranged from 0.74 (95% confidence interval, 0.69-0.78) for FRAIL Scale to 0.88 (95% confidence interval, 0.84-0.91) for the Walter Index. Calibration curves showed that the Walter Index, GPI, and FRAIL Scale were well calibrated, while the CCI was poor. Conclusion Combining the Brier score, discrimination and calibration, the Walter Index was confirmed for the first time to be the best model to predict the 1-year mortality risk of geriatric inpatients in China among the four models.
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Affiliation(s)
- Yuanyuan Li
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Xiaohong Liu
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Jiaojiao Li
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
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Cimini CCR, Delfino-Pereira P, Pires MC, Ramos LEF, Gomes AGDR, Jorge ADO, Fagundes AL, Garcia BM, Pessoa BP, de Carvalho CA, Ponce D, Rios DRA, Anschau F, Vigil FMB, Bartolazzi F, Grizende GMS, Vietta GG, Goedert GMDS, Nascimento GF, Vianna HR, Vasconcelos IM, de Alvarenga JC, Chatkin JM, Machado Rugolo J, Ruschel KB, Zandoná LB, Menezes LSM, de Castro LC, Souza MD, Carneiro M, Bicalho MAC, Cunha MIA, Sacioto MF, de Oliveira NR, Andrade PGS, Lutkmeier R, Menezes RM, Ribeiro ALP, Marcolino MS. Assessment of the ABC 2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores. Front Med (Lausanne) 2023; 10:1259055. [PMID: 38046414 PMCID: PMC10690599 DOI: 10.3389/fmed.2023.1259055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023] Open
Abstract
Background Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction. Methods Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample. Results Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). Conclusion The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.
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Affiliation(s)
- Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, Teófilo Otoni, Minas Gerais, Brazil
- Mucuri's Medical School and Telehealth Center, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni, Minas Gerais, Brazil
| | - Polianna Delfino-Pereira
- Universidade Federal de Minas Gerais and Institute for Health and Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | | | | | | | - Daniela Ponce
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, UNESP, Botucatu, São Paulo, Brazil
| | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | - Isabela Muzzi Vasconcelos
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - José Miguel Chatkin
- Hospital São Lucas PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
- Pontifica Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Machado Rugolo
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, UNESP, Botucatu, São Paulo, Brazil
| | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Universitário de Canoas, Canoas, Rio Grande do Sul, Brazil
| | | | | | | | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Maria Aparecida Camargos Bicalho
- Hospital João XXIII, Belo Horizonte, Minas Gerais, Brazil
- Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Cidade Administrativa de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Pedro Guido Soares Andrade
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel Lutkmeier
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Antonio Luiz Pinho Ribeiro
- Cardiology Service, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Institute for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Institute for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
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Jeon ET, Jung SJ, Yeo TY, Seo WK, Jung JM. Predicting short-term outcomes in atrial-fibrillation-related stroke using machine learning. Front Neurol 2023; 14:1243700. [PMID: 38020627 PMCID: PMC10663332 DOI: 10.3389/fneur.2023.1243700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Prognostic prediction and the identification of prognostic factors are critical during the early period of atrial-fibrillation (AF)-related strokes as AF is associated with poor outcomes in stroke patients. Methods Two independent datasets, namely, the Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke Patients (K-ATTENTION) and the Korea University Stroke Registry (KUSR), were used for internal and external validation, respectively. These datasets include common variables such as demographic, laboratory, and imaging findings during early hospitalization. Outcomes were unfavorable functional status with modified Rankin scores of 3 or higher and mortality at 3 months. We developed two machine learning models, namely, a tree-based model and a multi-layer perceptron (MLP), along with a baseline logistic regression model. The area under the receiver operating characteristic curve (AUROC) was used as the outcome metric. The Shapley additive explanation (SHAP) method was used to evaluate the contributions of variables. Results Machine learning models outperformed logistic regression in predicting both outcomes. For 3-month unfavorable outcomes, MLP exhibited significantly higher AUROC values of 0.890 and 0.859 in internal and external validation sets, respectively, than those of logistic regression. For 3-month mortality, both machine learning models exhibited significantly higher AUROC values than the logistic regression for internal validation but not for external validation. The most significant predictor for both outcomes was the initial National Institute of Health and Stroke Scale. Conclusion The explainable machine learning model can reliably predict short-term outcomes and identify high-risk patients with AF-related strokes.
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Affiliation(s)
- Eun-Tae Jeon
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Seung Jin Jung
- Department of Family Medicine, Gimpo Woori Hospital, Gimpo, Republic of Korea
| | - Tae Young Yeo
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
- Korea University Zebrafish Translational Medical Research Center, Ansan, Republic of Korea
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Kirigaya J, Iwahashi N, Abe T, Gohbara M, Hanajima Y, Horii M, Okada K, Matsuzawa Y, Yasuda S, Kosuge M, Ebina T, Takeuchi I, Uchida K, Tamura K, Hibi K. Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2023; 12:e029506. [PMID: 37850479 PMCID: PMC10727378 DOI: 10.1161/jaha.123.029506] [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: 01/16/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
Background Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST-elevation-myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2-dimensional echocardiography (2DE) findings are optimal for differentiating TAAAD from STEMI. Methods and Results This study included 340 patients with STEMI and 340 patients with TAAAD who underwent 2DE in the emergency department between 2012 and 2021. The proximal ascending aorta (PAA) diameter and other echocardiographic parameters were analyzed. PAA diameters were measured at 4 levels in the parasternal view: Valsalva, the sinotubular junction (STJ), the PAA at 1 cm above the STJ, and the PAA at 2 cm above the STJ. Receiver-operating characteristic curve analysis showed that Valsalva, STJ, PAA at 1 cm above the STJ, and PAA at 2 cm above the STJ were significant predictors of TAAAD (areas under the curve: 0.777, 0.924, 0.965, and 0.975, respectively; P<0.001) with the respective cutoff values of 39.4, 38.5, 39.8, and 41.2 mm. Multivariable analysis suggested that all 2DE parameters were significant predictors of TAAAD. Among the 2DE parameters examined, the incorporation of PAA at 2 cm above the STJ to clinical indicators exhibited the most significant diagnostic capability (C-statistics, 0.97; net reclassification improvement, 1.81; integrated discrimination improvement, 0.61). When only TAAAD with coronary malperfusion and STEMI were analyzed, the diagnostic utility of PAA at 1 cm above the STJ was evident (C-statistics, 0.99; net reclassification improvement, 1.79; integrated discrimination improvement, 0.67), with PAA at 2 cm above the STJ ranking second in diagnostic significance (C-statistics, 0.99; net reclassification improvement, 1.12; integrated discrimination improvement, 0.66). Conclusions PAA measurements were the most beneficial for diagnosing TAAAD in all 2DE findings and TAAAD from STEMI.
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Affiliation(s)
- Jin Kirigaya
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Takeru Abe
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Mutsuo Horii
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Keiji Uchida
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
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Hur MH, Park MK, Yip TCF, Chen CH, Lee HC, Choi WM, Kim SU, Lim YS, Park SY, Wong GLH, Sinn DH, Jin YJ, Kim SE, Peng CY, Shin HP, Chen CY, Kim HY, Lee HA, Seo YS, Jun DW, Yoon EL, Sohn JH, Ahn SB, Shim JJ, Jeong SW, Cho YK, Kim HS, Jang MJ, Kim YJ, Yoon JH, Lee JH. Personalized Antiviral Drug Selection in Patients With Chronic Hepatitis B Using a Machine Learning Model: A Multinational Study. Am J Gastroenterol 2023; 118:1963-1972. [PMID: 36881437 DOI: 10.14309/ajg.0000000000002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Tenofovir disoproxil fumarate (TDF) is reportedly superior or at least comparable to entecavir (ETV) for the prevention of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B; however, it has distinct long-term renal and bone toxicities. This study aimed to develop and validate a machine learning model (designated as Prediction of Liver cancer using Artificial intelligence-driven model for Network-antiviral Selection for hepatitis B [PLAN-S]) to predict an individualized risk of HCC during ETV or TDF therapy. METHODS This multinational study included 13,970 patients with chronic hepatitis B. The derivation (n = 6,790), Korean validation (n = 4,543), and Hong Kong-Taiwan validation cohorts (n = 2,637) were established. Patients were classified as the TDF-superior group when a PLAN-S-predicted HCC risk under ETV treatment is greater than under TDF treatment, and the others were defined as the TDF-nonsuperior group. RESULTS The PLAN-S model was derived using 8 variables and generated a c-index between 0.67 and 0.78 for each cohort. The TDF-superior group included a higher proportion of male patients and patients with cirrhosis than the TDF-nonsuperior group. In the derivation, Korean validation, and Hong Kong-Taiwan validation cohorts, 65.3%, 63.5%, and 76.4% of patients were classified as the TDF-superior group, respectively. In the TDF-superior group of each cohort, TDF was associated with a significantly lower risk of HCC than ETV (hazard ratio = 0.60-0.73, all P < 0.05). In the TDF-nonsuperior group, however, there was no significant difference between the 2 drugs (hazard ratio = 1.16-1.29, all P > 0.1). DISCUSSION Considering the individual HCC risk predicted by PLAN-S and the potential TDF-related toxicities, TDF and ETV treatment may be recommended for the TDF-superior and TDF-nonsuperior groups, respectively.
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Affiliation(s)
- Moon Haeng Hur
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Terry Cheuk-Fung Yip
- Medical Data Analytics Centre (MDAC), Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chien-Hung Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hyung-Chul Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won-Mook Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Suk Lim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Grace Lai-Hung Wong
- Medical Data Analytics Centre (MDAC), Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hyun Phil Shin
- Department of Gastroenterology and Hepatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chi-Yi Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Mitsuke A, Ohbo T, Arima J, Osako Y, Sakaguchi T, Matsushita R, Yoshino H, Tatarano S, Yamada Y, Sasaki H, Tanabe T, Fukuzawa N, Tanaka H, Nishio Y, Hideki E, Harada H. Low dose tacrolimus exposure and early steroid withdrawal with strict body weight control can improve post kidney transplant glucose tolerance in Japanese patients. PLoS One 2023; 18:e0287059. [PMID: 37819994 PMCID: PMC10566682 DOI: 10.1371/journal.pone.0287059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/26/2023] [Indexed: 10/13/2023] Open
Abstract
The development of diabetes mellitus (DM) after living donor kidney transplantation (KT) is a risk factor for worsening transplant kidney function, cardiac disease, and cerebrovascular disease, which may affect prognosis after KT. At our institution, all patients' glucose tolerance is evaluated perioperatively by oral glucose tolerance tests (OGTTs) at pre-KT, and 3, 6, and 12 month (mo.) after KT. We analyzed the insulinogenic index (ISI) and homeostasis model assessment beta cell (HOMA-β) based on the immunoreactive insulin (IRI) levels to determine how glucose tolerance changed after KT in 214 patients who had not been diagnosed with DM before KT. In addition, we analyzed the body mass index (BMI) which may also influence glucose tolerance after KT. The concentration of tacrolimus (TAC) in blood was also measured as the area under the curve (AUC) to examine its effects at each sampling point. The preoperative-OGTTs showed that DM was newly diagnosed in 22 of 214 patients (10.3%) who had not been given a diagnosis of DM by the pre-KT fasting blood sugar (FBS) tests. The glucose tolerance was improved in 15 of 22 DM patients at 12 mo. after KT. ISI and IRI deteriorated only at 3 mo. after KT but improved over time. There was a trend of an inverse correlation between HOMA-β and TAC-AUC. We also found inverse correlations between IRI and an increase in BMI from 3 to 12 mo. after KT. Early corticosteroid withdrawal or the steroid minimization protocol with tacrolimus to maintain a low level of diabetogenic tacrolimus and BMI decrease after KT used by our hospital individualizes lifestyle interventions for each patient might contribute to an improvement in post-KT glucose tolerance.
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Affiliation(s)
- Akihiko Mitsuke
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Hokkaido, Japan
| | - Takahiko Ohbo
- Department of Diabetes and Endocrine Medicine, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Junya Arima
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoichi Osako
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takashi Sakaguchi
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Matsushita
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hirofumi Yoshino
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shuichi Tatarano
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasutoshi Yamada
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hajime Sasaki
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Hokkaido, Japan
| | - Tatsu Tanabe
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Hokkaido, Japan
| | - Nobuyuki Fukuzawa
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Hokkaido, Japan
| | - Hiroshi Tanaka
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Hokkaido, Japan
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Enokida Hideki
- Department of Urology, Graduate of School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiroshi Harada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Hokkaido, Japan
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Jo H, Kim C, Gwon D, Lee J, Lee J, Park KM, Park S. Combining clinical and imaging data for predicting functional outcomes after acute ischemic stroke: an automated machine learning approach. Sci Rep 2023; 13:16926. [PMID: 37805568 PMCID: PMC10560215 DOI: 10.1038/s41598-023-44201-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023] Open
Abstract
This study aimed to develop and validate an automated machine learning (ML) system that predicts 3-month functional outcomes in acute ischemic stroke (AIS) patients by combining clinical and neuroimaging features. Functional outcomes were categorized as unfavorable (modified Rankin Scale ≥ 3) or not. A clinical model employing optimal clinical features (Model_A), a convolutional neural network model incorporating imaging data (Model_B), and an integrated model combining both imaging and clinical features (Model_C) were developed and tested to predict unfavorable outcomes. The developed models were compared with each other and with traditional risk-scoring models. The dataset comprised 4147 patients from a multicenter stroke registry, with 1268 (30.6%) experiencing unfavorable outcomes. Age, initial NIHSS, and early neurologic deterioration were identified as the most important clinical features. The ML model prediction achieved an area under the curves of 0.757 (95% CI 0.726-0.789) for Model_A, 0.725 (95% CI 0.693-0.755) for Model_B, and 0.786 (95% CI 0.757-0.814) for Model_C in the test set. The integrated models outperformed traditional risk-scoring models by 0.21 (95% CI 0.16-0.25) for HIAT and 0.15 (95% CI 0.11-0.19) for THRIVE. In conclusion, the integrated ML system enhanced stroke outcome prediction by combining imaging data and clinical features, outperforming traditional risk-scoring models.
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Affiliation(s)
- Hongju Jo
- Department of CGMS Sensor, Sensor R&D Center, i-SENS, Seoul, Republic of Korea
| | - Changi Kim
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Dowan Gwon
- Department of Digital&Biohealth, Group of AI/DX Business, KT, Seoul, Republic of Korea
| | - Jaeho Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, 48108, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, 48108, Busan, Republic of Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, 48108, Busan, Republic of Korea.
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das Graças José Ventura V, Pereira PD, Pires MC, Asevedo AA, de Oliveira Jorge A, Dos Santos ACP, de Moura Costa AS, Dos Reis Gomes AG, Lima BF, Pessoa BP, Cimini CCR, de Andrade CMV, Ponce D, Rios DRA, Pereira EC, Manenti ERF, de Almeida Cenci EP, Costa FR, Anschau F, Aranha FG, Vigil FMB, Bartolazzi F, Aguiar GG, Grizende GMS, Batista JDL, Neves JVB, Ruschel KB, do Nascimento L, de Oliveira LMC, Kopittke L, de Castro LC, Sacioto MF, Carneiro M, Gonçalves MA, Bicalho MAC, da Paula Sordi MA, da Cunha Severino Sampaio N, Paraíso PG, Menezes RM, Araújo SF, de Assis VCM, de Paula Farah K, Marcolino MS. Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients. BMC Nephrol 2023; 24:292. [PMID: 37794354 PMCID: PMC10552198 DOI: 10.1186/s12882-023-03341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Acute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality. METHODS This study is part of the "Brazilian COVID-19 Registry", a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score. RESULTS A total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48-70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909-0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914-0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69-0.73]). CONCLUSION The MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19.
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Affiliation(s)
- Vanessa das Graças José Ventura
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Polianna Delfino Pereira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Alisson Alves Asevedo
- Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (UFVJM), R. Cruzeiro, 01. , Teófilo Otoni, Minas Gerais, Brazil
| | - Alzira de Oliveira Jorge
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Hospital Risoleta Tolentino Neves, R. das Gabirobas, 01, Belo Horizonte, Brazil
| | | | | | | | - Beatriz Figueiredo Lima
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
| | - Bruno Porto Pessoa
- Hospital Júlia Kubitschek, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | - Christiane Corrêa Rodrigues Cimini
- Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (UFVJM), R. Cruzeiro, 01. , Teófilo Otoni, Minas Gerais, Brazil
- Hospital Santa Rosália, R. Do Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Daniela Ponce
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, Botucatu, Brazil
| | | | | | | | | | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | - Frederico Bartolazzi
- Hospital Santo Antônio, Pç. Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil
| | - Gabriella Genta Aguiar
- Universidade José Do Rosário Vellano (UNIFENAS), R. Boaventura, 50, Belo Horizonte, Brazil
| | | | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Medical School, Universidade Federal da Fronteira Sul, SC-484 Km 02, Chapecó, Brazil
| | - João Victor Baroni Neves
- Faculdade de Ciências Médicas de Minas Gerais, Al. Ezequiel Dias, 275, Belo Horizonte, Minas Gerais, Brazil
| | | | - Letícia do Nascimento
- Hospital Universitário de Santa Maria, Av. Roraima, 1000, Prédio 22, Santa Maria, Brazil
| | | | - Luciane Kopittke
- Hospital Nossa Senhora da Conceição, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Manuela Furtado Sacioto
- Faculdade de Ciências Médicas de Minas Gerais, Al. Ezequiel Dias, 275, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz Do Sul, Brazil
| | - Marcos André Gonçalves
- Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Maria Aparecida Camargos Bicalho
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Hospital João XXIII, Av. Professor Alfredo Balena, 400, Belo Horizonte, Brazil
| | - Mônica Aparecida da Paula Sordi
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, Botucatu, Brazil
| | | | - Pedro Gibson Paraíso
- Orizonti Instituto de Saúde E Longevidade, Av. José Do Patrocínio Pontes, 1355, Belo Horizonte, Brazil
| | | | | | | | - Katia de Paula Farah
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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Labott JR, Lu Y, Salmons HI, Camp CL, Wyles CC, Taunton MJ. Health and Socioeconomic Risk Factors for Unplanned Hospitalization Following Ambulatory Unicompartmental Knee Arthroplasty: Development of a Patient Selection Tool Using Machine Learning. J Arthroplasty 2023; 38:1982-1989. [PMID: 36709883 DOI: 10.1016/j.arth.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Identifying ambulatory surgical candidates at risk for adverse surgical outcomes can optimize outcomes. The purpose of this study was to develop and internally validate a machine learning (ML) algorithm to predict contributors to unexpected hospitalizations after ambulatory unicompartmental knee arthroplasty (UKA). METHODS A total of 2,521 patients undergoing UKA from 2006 to 2018 were retrospectively evaluated. Patients admitted overnight postoperatively were identified as those who had a length of stay ≥ 1 day were analyzed with four individual ML models (ie, random forest, extreme gradient boosting, adaptive boosting, and elastic net penalized logistic regression). An additional model was produced as a weighted ensemble of the four individual algorithms. Area under the receiver operating characteristics (AUROC) compared predictive capacity of these models to conventional logistic regression techniques. RESULTS Of the 2,521 patients identified, 103 (4.1%) required at least one overnight stay following ambulatory UKA. The ML ensemble model achieved the best performance based on discrimination assessed via internal validation (AUROC = 87.3), outperforming individual models and conventional logistic regression (AUROC = 81.9-85.7). The variables determined most important by the ensemble model were cumulative time in the operating room, utilization of general anesthesia, increasing age, and patient residency in more urban areas. The model was integrated into a web-based open-access application. CONCLUSION The ensemble gradient-boosted ML algorithm demonstrated the highest performance in identifying factors contributing to unexpected hospitalizations in patients receiving UKA. This tool allows physicians and healthcare systems to identify patients at a higher risk of needing inpatient care after UKA.
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Affiliation(s)
- Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Lab (OSAIL), Mayo Clinic, Rochester, Minnesota
| | - Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Lab (OSAIL), Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Lab (OSAIL), Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Lab (OSAIL), Mayo Clinic, Rochester, Minnesota
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Campagnaro T, Poletto E, Tarchi P, Rattizzato S, Verlato G, Conci S, Pedrazzani C, De Manzini N, Guglielmi A, Ruzzenente A. Evaluation of the ACS-NSQIP Surgical Risk Calculator in Patients with Hepatic Metastases from Colorectal Cancer Undergoing Liver Resection. J Gastrointest Surg 2023; 27:2114-2125. [PMID: 37580490 PMCID: PMC10579123 DOI: 10.1007/s11605-023-05784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC) has been designed to predict morbidity and mortality and help stratify surgical patients. This study evaluates the performance of the SRC for patients undergoing surgery for colorectal liver metastases (CRLM). METHODS SRC was retrospectively computed for patients undergoing liver or simultaneous colon and liver surgery for colorectal cancer (CRC) in two high tertiary referral centres from 2011 to 2020. C-statistics and Brier score were calculated as a mean of discrimination and calibration respectively, for both group and for every level of surgeon adjustment score (SAS) for liver resections in case of simultaneous liver-colon surgery. An AUC ≥ 0.7 shows acceptable discrimination; a Brier score next to 0 means the prediction tool has good calibration. RESULTS Four hundred ten patients were included, 153 underwent simultaneous resection, and 257 underwent liver-only resections. For simultaneous surgery, the ACS-NSQIP SRC showed good calibration and discrimination only for cardiac complication (AUC = 0.720, 0.740, and 0.702 for liver resection unadjusted, SAS-2, and SAS-3 respectively; 0.714 for colon resection; and Brier score = 0.04 in every case). For liver-only surgery, it only showed good calibration for cardiac complications (Brier score = 0.03). The SRC underestimated the incidence of overall complications, pneumonia, cardiac complications, and the length of hospital stay. CONCLUSIONS ACS-NSQIP SRC showed good predicting capabilities only for 1 out of 5 evaluated outcomes; therefore, it is not a reliable tool for patients undergoing liver surgery for CRLM, both in the simultaneous and staged resections.
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Affiliation(s)
- Tommaso Campagnaro
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy
| | - Edoardo Poletto
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy
| | - Paola Tarchi
- Surgical Clinic, University Hospital of Trieste (Azienda Sanitaria Giuliano-Isontina), 34149, Trieste, Italy
| | - Simone Rattizzato
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy
| | - Giuseppe Verlato
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Simone Conci
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy
| | - Nicolò De Manzini
- Surgical Clinic, University Hospital of Trieste (Azienda Sanitaria Giuliano-Isontina), 34149, Trieste, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy
| | - Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy.
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Braun J, Sahli SD, Spahn DR, Röder D, Neb H, Lotz G, Aser R, Wilhelm MJ, Kaserer A. Predicting Survival for Veno-Arterial ECMO Using Conditional Inference Trees-A Multicenter Study. J Clin Med 2023; 12:6243. [PMID: 37834887 PMCID: PMC10573956 DOI: 10.3390/jcm12196243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Despite increasing use and understanding of the process, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy is still associated with considerable mortality. Personalized and quick survival predictions using machine learning methods can assist in clinical decision making before ECMO insertion. METHODS This is a multicenter study to develop and validate an easy-to-use prognostic model to predict in-hospital mortality of VA-ECMO therapy, using unbiased recursive partitioning with conditional inference trees. We compared two sets with different numbers of variables (small and comprehensive), all of which were available just before ECMO initiation. The area under the curve (AUC), the cross-validated Brier score, and the error rate were applied to assess model performance. Data were collected retrospectively between 2007 and 2019. RESULTS 837 patients were eligible for this study; 679 patients in the derivation cohort (median (IQR) age 60 (49 to 69) years; 187 (28%) female patients) and a total of 158 patients in two external validation cohorts (median (IQR) age 57 (49 to 65) and 70 (63 to 76) years). For the small data set, the model showed a cross-validated error rate of 35.79% and an AUC of 0.70 (95% confidence interval from 0.66 to 0.74). In the comprehensive data set, the error rate was the same with a value of 35.35%, with an AUC of 0.71 (95% confidence interval from 0.67 to 0.75). The mean Brier scores of the two models were 0.210 (small data set) and 0.211 (comprehensive data set). External validation showed an error rate of 43% and AUC of 0.60 (95% confidence interval from 0.52 to 0.69) using the small tree and an error rate of 35% with an AUC of 0.63 (95% confidence interval from 0.54 to 0.72) using the comprehensive tree. There were large differences between the two validation sets. CONCLUSIONS Conditional inference trees are able to augment prognostic clinical decision making for patients undergoing ECMO treatment. They may provide a degree of accuracy in mortality prediction and prognostic stratification using readily available variables.
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Affiliation(s)
- Julia Braun
- Departments of Biostatistics and Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland;
| | - Sebastian D. Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (D.R.S.)
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (D.R.S.)
| | - Daniel Röder
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Holger Neb
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60596 Frankfurt, Germany; (H.N.); (G.L.)
| | - Gösta Lotz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60596 Frankfurt, Germany; (H.N.); (G.L.)
| | - Raed Aser
- Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, 8091 Zurich, Switzerland; (R.A.); (M.J.W.)
| | - Markus J. Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, 8091 Zurich, Switzerland; (R.A.); (M.J.W.)
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (D.R.S.)
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Choi N, Jang JY, Kim MJ, Ryu SS, Jung YH, Jeong HS. Prediction of Maxillary Bone Invasion in Hard Palate/Upper Alveolus Cancer: A Multi-Center Retrospective Study. Cancers (Basel) 2023; 15:4699. [PMID: 37835393 PMCID: PMC10572084 DOI: 10.3390/cancers15194699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND maxillary bone invasion (MBI) is not uncommon in hard palate or upper alveolus (HP/UA) cancer; however, there have been relatively few reports about the MBI of HP/UA cancer. PATIENTS AND METHODS this was a multi-center retrospective study, enrolling 144 cases of HP/UA cancer. MBI was defined by surgical pathology or radiology follow-up. The multiple prediction models for MBI were developed in total cases and in cases having primary bone resection, using clinical and radiological variables. RESULTS computerized tomography (CT) alone predicted MBI, with an area under receiver operating curve (AUC) of 0.779 (95% confidence interval (CI) = 0.712-0.847). The AUC was increased in a model that combined tumor dimensions and clinical factors (male sex and nodal metastasis) (0.854 (95%CI = 0.790-0.918)). In patients who underwent 18fluorodeoxyglucose positron emission tomography/CT (PET/CT), the discrimination performance of a model including the maximal standardized uptake value (SUVmax) had an AUC of 0.911 (95%CI = 0.847-0.975). The scoring system using CT finding, tumor dimension, and clinical factors, with/without PET/CT SUVmax clearly distinguished low-, intermediate-, and high-risk groups for MBI. CONCLUSION using information from CT, tumor dimension, clinical factors, and the SUVmax value, the MBI of HP/UA cancer can be predicted with a relatively high discrimination performance.
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Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Jeon Yeob Jang
- Department of Otolaryngology, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, Republic of Korea;
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Sung Seok Ryu
- Department of Otolaryngology, Ulsan University School of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea;
| | - Young Ho Jung
- Department of Otolaryngology, Ulsan University School of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea;
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
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Veeramani A, Zhang AS, Blackburn AZ, Etzel CM, DiSilvestro KJ, McDonald CL, Daniels AH. An Artificial Intelligence Approach to Predicting Unplanned Intubation Following Anterior Cervical Discectomy and Fusion. Global Spine J 2023; 13:1849-1855. [PMID: 35132907 PMCID: PMC10556901 DOI: 10.1177/21925682211053593] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Level III retrospective database study. OBJECTIVES The purpose of this study is to determine if machine learning algorithms are effective in predicting unplanned intubation following anterior cervical discectomy and fusion (ACDF). METHODS The National Surgical Quality Initiative Program (NSQIP) was queried to select patients who had undergone ACDF. Machine learning analysis was conducted in Python and multivariate regression analysis was conducted in R. C-Statistics area under the curve (AUC) and prediction accuracy were used to measure the classifier's effectiveness in distinguishing cases. RESULTS In total, 54 502 patients met the study criteria. Of these patients, .51% underwent an unplanned re-intubation. Machine learning algorithms accurately classified between 72%-100% of the test cases with AUC values of between .52-.77. Multivariable regression indicated that the number of levels fused, male sex, COPD, American Society of Anesthesiologists (ASA) > 2, increased operating time, Age > 65, pre-operative weight loss, dialysis, and disseminated cancer were associated with increased risk of unplanned intubation. CONCLUSIONS The models presented here achieved high accuracy in predicting risk factors for re-intubation following ACDF surgery. Machine learning analysis may be useful in identifying patients who are at a higher risk of unplanned post-operative re-intubation and their treatment plans can be modified to prophylactically prevent respiratory compromise and consequently unplanned re-intubation.
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Affiliation(s)
- Ashwin Veeramani
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew S Zhang
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy Z. Blackburn
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine M. Etzel
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin J. DiSilvestro
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H. Daniels
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Xu H, Bowblis JR, Becerra AZ, Intrator O. Developing a Machine Learning Risk-adjustment Method for Hospitalizations and Emergency Department Visits of Nursing Home Residents With Dementia. Med Care 2023; 61:619-626. [PMID: 37440719 PMCID: PMC10526959 DOI: 10.1097/mlr.0000000000001882] [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] [Indexed: 07/15/2023]
Abstract
BACKGROUND Long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD) are at high risk of hospital transfers. Machine learning might improve risk-adjustment methods for NHs. OBJECTIVES The objective of this study was to develop and compare NH risk-adjusted rates of hospitalizations and emergency department (ED) visits among long-stay residents with ADRD using Extreme Gradient Boosting (XGBoost) and logistic regression. RESEARCH DESIGN Secondary analysis of national Medicare claims and NH assessment data in 2012 Q3. Data were equally split into the training and test sets. Both XGBoost and logistic regression predicted any hospitalization and ED visit using 58 predictors. NH-level risk-adjusted rates from XGBoost and logistic regression were constructed and compared. Multivariate regressions examined NH and market factors associated with rates of hospitalization and ED visits. SUBJECTS Long-stay Medicare residents with ADRD (N=413,557) from 14,057 NHs. RESULTS A total of 8.1% and 8.9% residents experienced any hospitalization and ED visit in a quarter, respectively. XGBoost slightly outperformed logistic regression in area under the curve (0.88 vs. 0.86 for hospitalization; 0.85 vs. 0.83 for ED visit). NH-level risk-adjusted rates from XGBoost were slightly lower than logistic regression (hospitalization=8.3% and 8.4%; ED=8.9% and 9.0%, respectively), but were highly correlated. Facility and market factors associated with the XGBoost and logistic regression-adjusted hospitalization and ED rates were similar. NHs serving more residents with ADRD and having a higher registered nurse-to-total nursing staff ratio had lower rates. CONCLUSIONS XGBoost and logistic regression provide comparable estimates of risk-adjusted hospitalization and ED rates.
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Affiliation(s)
- Huiwen Xu
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - John R. Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, OH
- Scripps Gerontology Center, Miami University, Oxford, OH
| | - Adan Z. Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY
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Kataoka Y, Taito S, Yamamoto N, So R, Tsutsumi Y, Anan K, Banno M, Tsujimoto Y, Wada Y, Sagami S, Tsujimoto H, Nihashi T, Takeuchi M, Terasawa T, Iguchi M, Kumasawa J, Ichikawa T, Furukawa R, Yamabe J, Furukawa TA. An open competition involving thousands of competitors failed to construct useful abstract classifiers for new diagnostic test accuracy systematic reviews. Res Synth Methods 2023; 14:707-717. [PMID: 37337729 DOI: 10.1002/jrsm.1649] [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: 12/14/2022] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
There are currently no abstract classifiers, which can be used for new diagnostic test accuracy (DTA) systematic reviews to select primary DTA study abstracts from database searches. Our goal was to develop machine-learning-based abstract classifiers for new DTA systematic reviews through an open competition. We prepared a dataset of abstracts obtained through database searches from 11 reviews in different clinical areas. As the reference standard, we used the abstract lists that required manual full-text review. We randomly splitted the datasets into a train set, a public test set, and a private test set. Competition participants used the training set to develop classifiers and validated their classifiers using the public test set. The classifiers were refined based on the performance of the public test set. They could submit as many times as they wanted during the competition. Finally, we used the private test set to rank the submitted classifiers. To reduce false exclusions, we used the Fbeta measure with a beta set to seven for evaluating classifiers. After the competition, we conducted the external validation using a dataset from a cardiology DTA review. We received 13,774 submissions from 1429 teams or persons over 4 months. The top-honored classifier achieved a Fbeta score of 0.4036 and a recall of 0.2352 in the external validation. In conclusion, we were unable to develop an abstract classifier with sufficient recall for immediate application to new DTA systematic reviews. Further studies are needed to update and validate classifiers with datasets from other clinical areas.
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Affiliation(s)
- Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Shunsuke Taito
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Norio Yamamoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Ryuhei So
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
- CureApp, Inc., Tokyo, Japan
| | - Yusuke Tsutsumi
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Keisuke Anan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masahiro Banno
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Tsujimoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Oku Medical Clinic, Osaka, Japan
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Yoshitaka Wada
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takashi Nihashi
- Department of Radiology, Komaki City Hospital, Komaki, Japan
| | - Motoki Takeuchi
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masahiro Iguchi
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Junji Kumasawa
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Critical Care Medicine, Sakai City Medical Center, Sakai, Japan
| | | | | | | | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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Strum RP, Mowbray FI, Zargoush M, Jones AP. Prehospital prediction of hospital admission for emergent acuity patients transported by paramedics: A population-based cohort study using machine learning. PLoS One 2023; 18:e0289429. [PMID: 37616228 PMCID: PMC10449470 DOI: 10.1371/journal.pone.0289429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The closest emergency department (ED) may not always be the optimal hospital for certain stable high acuity patients if further distanced ED's can provide specialized care or are less overcrowded. Machine learning (ML) predictions may support paramedic decision-making to transport a subgroup of emergent patients to a more suitable, albeit more distanced, ED if hospital admission is unlikely. We examined whether characteristics known to paramedics in the prehospital setting were predictive of hospital admission in emergent acuity patients. MATERIALS AND METHODS We conducted a population-level cohort study using four ML algorithms to analyze ED visits of the National Ambulatory Care Reporting System from January 1, 2018 to December 31, 2019 in Ontario, Canada. We included all adult patients (≥18 years) transported to the ED by paramedics with an emergent Canadian Triage Acuity Scale score. We included eight characteristic classes as model predictors that are recorded at ED triage. All ML algorithms were trained and assessed using 10-fold cross-validation to predict hospital admission from the ED. Predictive model performance was determined using the area under curve (AUC) with 95% confidence intervals and probabilistic accuracy using the Brier Scaled score. Variable importance scores were computed to determine the top 10 predictors of hospital admission. RESULTS All machine learning algorithms demonstrated acceptable accuracy in predicting hospital admission (AUC 0.77-0.78, Brier Scaled 0.22-0.24). The characteristics most predictive of admission were age between 65 to 105 years, referral source from a residential care facility, presenting with a respiratory complaint, and receiving home care. DISCUSSION Hospital admission was accurately predicted based on patient characteristics known prehospital to paramedics prior to arrival. Our results support consideration of policy modification to permit certain emergent acuity patients to be transported to a further distanced ED. Additionally, this study demonstrates the utility of ML in paramedic and prehospital research.
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Affiliation(s)
- Ryan P. Strum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fabrice I. Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- College of Nursing, Michigan State University, East Lansing, Michigan, United States of America
| | - Manaf Zargoush
- Department of Health Policy and Management, McMaster University, Hamilton, Ontario, Canada
| | - Aaron P. Jones
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, McMaster University, Hamilton, Ontario, Canada
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Xiu Y, Jiang C, Zhang S, Yu X, Qiao K, Huang Y. Prediction of nonsentinel lymph node metastasis in breast cancer patients based on machine learning. World J Surg Oncol 2023; 21:244. [PMID: 37563717 PMCID: PMC10416453 DOI: 10.1186/s12957-023-03109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Develop the best machine learning (ML) model to predict nonsentinel lymph node metastases (NSLNM) in breast cancer patients. METHODS From June 2016 to August 2022, 1005 breast cancer patients were included in this retrospective study. Univariate and multivariate analyses were performed using logistic regression. Six ML models were introduced, and their performance was compared. RESULTS NSLNM occurred in 338 (33.6%) of 1005 patients. The best ML model was XGBoost, whose average area under the curve (AUC) based on 10-fold cross-verification was 0.722. It performed better than the nomogram, which was based on logistic regression (AUC: 0.764 vs. 0.706). CONCLUSIONS The ML model XGBoost can well predict NSLNM in breast cancer patients.
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Affiliation(s)
- Yuting Xiu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150086, China
| | - Cong Jiang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150086, China
| | - Shiyuan Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150086, China
| | - Xiao Yu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150086, China
| | - Kun Qiao
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150086, China.
| | - Yuanxi Huang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, 150086, China.
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Momeni N, Ali Boroomand M, Roozmand Z, Namiranian N, Hamzian N. Normal tissue complication probability of acute eyelids erythema following radiotherapy of head and neck cancers and skull-base tumors. Phys Med 2023; 112:102621. [PMID: 37329741 DOI: 10.1016/j.ejmp.2023.102621] [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: 01/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE Radiation therapy is broadly used as one of the main treatment methods for patients with head and neck cancers and skull base tumors. However, it can lead to normal tissue complications. Therefore, this study aimed to model normal tissue complication probability (NTCP) of eyelid skin erythema after radiation therapy. METHODS The dataset of 45 patients with head and neck and skull base tumors was prospectively collected from their dose-volume histograms (DVHs). Grade 1 + eyelid skin erythema based on the Common Terminology Criteria for Adverse Events (CTCAE 4.0) was evaluated as the endpoint after a three-month follow-up. The Lyman-Kutcher-Burman (LKB) radiobiological model was developed based on generalized equivalent uniform dose (gEUD). Model parameters were calculated by maximum likelihood estimation. Model performance was evaluated by ROC-AUC, Brier score and Hosmer-Lemeshow test. RESULTS After three months of follow-up, 13.33% of patients experienced eyelids skin erythema grade 1 or more. The parameters of the LKB model were: TD50 = 30 Gy, m = 0.14, and n = 0.10. The model showed good predictive performance with ROC-AUC = 0.80 (CI:0.66-0.94) and a Brier score of 0.20. CONCLUSIONS In this study, NTCP of eyelid skin erythema was modeled based on the LKB radiobiological model with good predictive performance.
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Affiliation(s)
- Nastaran Momeni
- Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Boroomand
- Clinical oncology department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Roozmand
- Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Diabetes research center of Alikhani, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nima Hamzian
- Department of Medical Physics, School of Medicine, Shahid Sadoughi Universi of Medical Sciences, Yazd, Iran.
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