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Xu W, Zhou Y, Jiang Q, Fang Y, Yang Q. Risk prediction models for diabetic nephropathy among type 2 diabetes patients in China: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1407348. [PMID: 39022345 PMCID: PMC11251916 DOI: 10.3389/fendo.2024.1407348] [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: 03/26/2024] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
Objective This study systematically reviews and meta-analyzes existing risk prediction models for diabetic kidney disease (DKD) among patients with type 2 diabetes, aiming to provide references for scholars in China to develop higher-quality risk prediction models. Methods We searched databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese Science and Technology Journal Database, Chinese Biomedical Literature Database (CBM), PubMed, Web of Science, Embase, and the Cochrane Library for studies on the construction of DKD risk prediction models among type 2 diabetes patients, up until 28 December 2023. Two researchers independently screened the literature and extracted and evaluated information according to a data extraction form and bias risk assessment tool for prediction model studies. The area under the curve (AUC) values of the models were meta-analyzed using STATA 14.0 software. Results A total of 32 studies were included, with 31 performing internal validation and 22 reporting calibration. The incidence rate of DKD among patients with type 2 diabetes ranged from 6.0% to 62.3%. The AUC ranged from 0.713 to 0.949, indicating the prediction models have fair to excellent prediction accuracy. The overall applicability of the included studies was good; however, there was a high overall risk of bias, mainly due to the retrospective nature of most studies, unreasonable sample sizes, and studies conducted in a single center. Meta-analysis of the models yielded a combined AUC of 0.810 (95% CI: 0.780-0.840), indicating good predictive performance. Conclusion Research on DKD risk prediction models for patients with type 2 diabetes in China is still in its initial stages, with a high overall risk of bias and a lack of clinical application. Future efforts could focus on constructing high-performance, easy-to-use prediction models based on interpretable machine learning methods and applying them in clinical settings. Registration This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a recognized guideline for such research. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024498015.
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Affiliation(s)
| | | | | | | | - Qian Yang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
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Surian NU, Batagov A, Wu A, Lai WB, Sun Y, Bee YM, Dalan R. A digital twin model incorporating generalized metabolic fluxes to identify and predict chronic kidney disease in type 2 diabetes mellitus. NPJ Digit Med 2024; 7:140. [PMID: 38789510 PMCID: PMC11126707 DOI: 10.1038/s41746-024-01108-6] [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: 09/29/2023] [Accepted: 04/12/2024] [Indexed: 05/26/2024] Open
Abstract
We have developed a digital twin-based CKD identification and prediction model that leverages generalized metabolic fluxes (GMF) for patients with Type 2 Diabetes Mellitus (T2DM). GMF digital twins utilized basic clinical and physiological biomarkers as inputs for identification and prediction of CKD. We employed four diverse multi-ethnic cohorts (n = 7072): a Singaporean cohort (EVAS, n = 289) and a North American cohort (NHANES, n = 1044) for baseline CKD identification, and two multi-center Singaporean cohorts (CDMD, n = 2119 and SDR, n = 3627) for 3-year CKD prediction and risk stratification. We subsequently conducted a comprehensive study utilizing a single dataset to evaluate the clinical utility of GMF for CKD prediction. The GMF-based identification model performed strongly, achieving an AUC between 0.80 and 0.82. In prediction, the GMF generated with complete parameters attained high performance with an AUC of 0.86, while with incomplete parameters, it achieved an AUC of 0.75. The GMF-based prediction model utilizing complete inputs is the standard implementation of our algorithm: HealthVector Diabetes®. We have established the GMF digital twin-based model as a robust clinical tool capable of predicting and stratifying the risk of future CKD within a 3-year time horizon. We report the correlation of GMF with basic input parameters, their ability to differentiate between future health states and medication status at baseline, and their capability to quantify CKD progression rates. This holistic methodology provides insights into patients' health states and CKD progression rates based on GMF metabolic profile differences, enabling personalized care plans.
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Affiliation(s)
| | - Arsen Batagov
- Mesh Bio Pte. Ltd., 10 Anson Rd, #22-02, 079903, Singapore, Singapore
| | - Andrew Wu
- Mesh Bio Pte. Ltd., 10 Anson Rd, #22-02, 079903, Singapore, Singapore
| | - Wen Bin Lai
- Mesh Bio Pte. Ltd., 10 Anson Rd, #22-02, 079903, Singapore, Singapore
| | - Yan Sun
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08, 138543, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore.
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore, Singapore.
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Kanbour S, Harris C, Lalani B, Wolf RM, Fitipaldi H, Gomez MF, Mathioudakis N. Machine Learning Models for Prediction of Diabetic Microvascular Complications. J Diabetes Sci Technol 2024; 18:273-286. [PMID: 38189280 PMCID: PMC10973856 DOI: 10.1177/19322968231223726] [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] [Indexed: 01/09/2024]
Abstract
IMPORTANCE AND AIMS Diabetic microvascular complications significantly impact morbidity and mortality. This review focuses on machine learning/artificial intelligence (ML/AI) in predicting diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). METHODS A comprehensive PubMed search from 1990 to 2023 identified studies on ML/AI models for diabetic microvascular complications. The review analyzed study design, cohorts, predictors, ML techniques, prediction horizon, and performance metrics. RESULTS Among the 74 identified studies, 256 featured internally validated ML models and 124 had externally validated models, with about half being retrospective. Since 2010, there has been a rise in the use of ML for predicting microvascular complications, mainly driven by DKD research across 27 countries. A more modest increase in ML research on DR and DN was observed, with publications from fewer countries. For all microvascular complications, predictive models achieved a mean (standard deviation) c-statistic of 0.79 (0.09) on internal validation and 0.72 (0.12) on external validation. Diabetic kidney disease models had the highest discrimination, with c-statistics of 0.81 (0.09) on internal validation and 0.74 (0.13) on external validation, respectively. Few studies externally validated prediction of DN. The prediction horizon, outcome definitions, number and type of predictors, and ML technique significantly influenced model performance. CONCLUSIONS AND RELEVANCE There is growing global interest in using ML for predicting diabetic microvascular complications. Research on DKD is the most advanced in terms of publication volume and overall prediction performance. Both DR and DN require more research. External validation and adherence to recommended guidelines are crucial.
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Affiliation(s)
| | - Catharine Harris
- Division of Endocrinology, Diabetes,
& Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Benjamin Lalani
- Division of Endocrinology, Diabetes,
& Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Risa M. Wolf
- Division of Pediatric Endocrinology,
Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund
University Diabetes Centre, Lund University, Malmö, Sweden
| | - Maria F. Gomez
- Department of Clinical Sciences, Lund
University Diabetes Centre, Lund University, Malmö, Sweden
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes,
& Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
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Lu P, Luo Y, Ying Z, Zhang J, Tu X, Chen L, Chen X, Cao Y, Huang Z. Prediction of injury localization in preoperative patients with gastrointestinal perforation: a multiomics model analysis. BMC Gastroenterol 2024; 24:6. [PMID: 38166815 PMCID: PMC10759549 DOI: 10.1186/s12876-023-03092-9] [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: 06/25/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The location of gastrointestinal perforation is essential for severity evaluation and optimizing the treatment approach. We aimed to retrospectively analyze the clinical characteristics, laboratory parameters, and imaging features of patients with gastrointestinal perforation and construct a predictive model to distinguish the location of upper and lower gastrointestinal perforation. METHODS A total of 367 patients with gastrointestinal perforation admitted to the department of emergency surgery in Fujian Medical University Union Hospital between March 2014 and December 2020 were collected. Patients were randomly divided into training set and test set in a ratio of 7:3 to establish and verify the prediction model by logistic regression. The receiver operating characteristic curve, calibration map, and clinical decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the prediction model, respectively. The multiomics model was validated by stratification analysis in the prediction of severity and prognosis of patients with gastrointestinal perforation. RESULTS The following variables were identified as independent predictors in lower gastrointestinal perforation: monocyte absolute value, mean platelet volume, albumin, fibrinogen, pain duration, rebound tenderness, free air in peritoneal cavity by univariate logistic regression analysis and stepwise regression analysis. The area under the receiver operating characteristic curve of the prediction model was 0.886 (95% confidence interval, 0.840-0.933). The calibration curve shows that the prediction accuracy and the calibration ability of the prediction model are effective. Meanwhile, the decision curve results show that the net benefits of the training and test sets are greater than those of the two extreme models as the threshold probability is 20-100%. The multiomics model score can be calculated via nomogram. The higher the stratification of risk score array, the higher the number of transferred patients who were admitted to the intensive care unit (P < 0.001). CONCLUSION The developed multiomics model including monocyte absolute value, mean platelet volume, albumin, fibrinogen, pain duration, rebound tenderness, and free air in the peritoneal cavity has good discrimination and calibration. This model can assist surgeons in distinguishing between upper and lower gastrointestinal perforation and to assess the severity of the condition.
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Affiliation(s)
- Pingxia Lu
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China
| | - Yue Luo
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China
| | - Ziling Ying
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China
| | - Junrong Zhang
- Department of Emergency Surgery, Fujian Medical University Union Hospital, No.29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
| | - Xiaoxian Tu
- Department of Medical records management room, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Lihong Chen
- Department of Radiology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Xianqiang Chen
- Department of Emergency Surgery, Fujian Medical University Union Hospital, No.29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
| | - Yingping Cao
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
| | - Zhengyuan Huang
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China.
- Department of Emergency Surgery, Fujian Medical University Union Hospital, No.29 Xin quan Road, Fuzhou, 350001, Fujian Province, China.
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Guixue G, Yifu P, Yuan G, Xialei L, Fan S, Qian S, Jinjin X, Linna Z, Xiaozuo Z, Wen F, Wen Y. Progress of the application clinical prediction model in polycystic ovary syndrome. J Ovarian Res 2023; 16:230. [PMID: 38007488 PMCID: PMC10675861 DOI: 10.1186/s13048-023-01310-2] [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: 07/02/2023] [Accepted: 11/05/2023] [Indexed: 11/27/2023] Open
Abstract
Clinical prediction models play an important role in the field of medicine. These can help predict the probability of an individual suffering from disease, complications, and treatment outcomes by applying specific methodologies. Polycystic ovary syndrome (PCOS) is a common disease with a high incidence rate, huge heterogeneity, short- and long-term complications, and complex treatments. In this systematic review study, we reviewed the progress of clinical prediction models in PCOS patients, including diagnosis and prediction models for PCOS complications and treatment outcomes. We aimed to provide ideas for medical researchers and clues for the management of PCOS. In the future, models with poor accuracy can be greatly improved by adding well-known parameters and validations, which will further expand our understanding of PCOS in terms of precision medicine. By developing a series of predictive models, we can make the definition of PCOS more accurate, which can improve the diagnosis of PCOS and reduce the likelihood of false positives and false negatives. It will also help discover complications earlier and treatment outcomes being known earlier, which can result in better outcomes for women with PCOS.
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Affiliation(s)
- Guan Guixue
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Pu Yifu
- Laboratory of Genetic Disease and Perinatal Medicine, Key laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Gao Yuan
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Liu Xialei
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Shi Fan
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Sun Qian
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Xu Jinjin
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Zhang Linna
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Zhang Xiaozuo
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Feng Wen
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Yang Wen
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China.
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China.
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China.
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Zhu L, Wang X, Sun J, Qian Q, Yu J, An X. Hyperuricemia Predicts the Progression of Type 2 Diabetic Kidney Disease in Chinese Patients. Diabetes Ther 2023; 14:581-591. [PMID: 36757669 PMCID: PMC9981872 DOI: 10.1007/s13300-023-01374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Diabetic kidney disease (DKD) has a high global disease burden and substantially increases the risk of end-stage renal disease and cardiovascular events. High levels of serum uric acid (SUA), or hyperuricemia, may indicate patients with type 2 diabetes (T2D) at risk for kidney disease. METHODS This study explored the association between SUA levels and progression of kidney disease among patients with T2D. A cross-sectional study of 993 Chinese patients aged 20-75 years with T2D and DKD was conducted. Patients were stratified by progression risk of kidney disease based on estimated glomerular filtration rate and ratio of urinary albumin to creatinine, according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ordinal logistic regression was used to assess associations between SUA and different KDIGO risk categories. RESULTS Among 768 patients in the final analysis, those with hyperuricemia and higher SUA were more likely to be assigned to higher KDIGO risk categories. Patients with SUA > 420 μmol/L were ninefold more likely to be in a higher KDIGO risk category than those with SUA < 300 μmol/L (odds risk 9.74, 95% confidence interval 5.47-17.33, P < 0.001). CONCLUSIONS Hyperuricemia may be associated with higher risk of DKD progression in individuals with T2D.
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Affiliation(s)
- Lin Zhu
- Physical Examination Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Xuening Wang
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Jiaxing Sun
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Qi Qian
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Jiangyi Yu
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China.
| | - Xiaofei An
- Department of Endocrinology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China.
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Chen Y, Wang Y, Shen Y, Dai H, Huang X, Fang L, Huang X, Shen Y, Yuan L. A dynamic nomogram for predicting survival among diabetic patients on maintenance hemodialysis. Ther Apher Dial 2023; 27:39-49. [PMID: 35731627 DOI: 10.1111/1744-9987.13901] [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: 01/05/2022] [Revised: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Among maintenance hemodialysis (MHD) patients, ones with diabetes mellitus (DM) are known to have the worst outcome. METHODS A total of 263 MHD patients were included, a dynamic nomogram was established based on multivariable Cox regression analysis. RESULTS The median overall survival (OS) time was 46 months. The 1-, 3-, and 5-year OS rates were 90.9%, 70.5% and 53.9%, respectively. The multivariable Cox regression analysis indicated that DM duration, cardiovascular complication, baseline values before starting MHD for estimated glomerular filtration rate and serum phosphate were independent risk factors. The C-index of the dynamic nomogram was 0.745 and the calibration curves showed optimal agreement between the model prediction and actual observation for predicting survival probabilities. CONCLUSIONS Our study was the first to establish dynamic nomogram among diabetic MHD patients, the fast and convenient online tool can be used for individual risk estimation at the point of prognosis prediction.
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Affiliation(s)
- Ying Chen
- Department of Occupational Health, Nantong Center for Disease Control and Prevention, Nantong, Jiangsu, P.R. China
| | - Yao Wang
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China
| | - Yan Shen
- Department of Nephrology, The First People's Hospital of Nantong, Nantong, Jiangsu, P.R. China
| | - Houyong Dai
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China
| | - Xinzhong Huang
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China
| | - Li Fang
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China
| | - Xi Huang
- School of Mechanical and Engineering, Nantong University, Nantong, Jiangsu, P.R. China
| | - Yi Shen
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Li Yuan
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P.R. China
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Nomogram-Based Chronic Kidney Disease Prediction Model for Type 1 Diabetes Mellitus Patients Using Routine Pathological Data. J Pers Med 2022; 12:jpm12091507. [PMID: 36143293 PMCID: PMC9501949 DOI: 10.3390/jpm12091507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) patients are a significant threat to chronic kidney disease (CKD) development during their life. However, there is always a high chance of delay in CKD detection because CKD can be asymptomatic, and T1DM patients bypass traditional CKD tests during their routine checkups. This study aims to develop and validate a prediction model and nomogram of CKD in T1DM patients using readily available routine checkup data for early CKD detection. This research utilized 1375 T1DM patients’ sixteen years of longitudinal data from multi-center Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials conducted at 28 sites in the USA and Canada and considered 17 routinely available features. Three feature ranking algorithms, extreme gradient boosting (XGB), random forest (RF), and extremely randomized trees classifier (ERT), were applied to create three feature ranking lists, and logistic regression analyses were performed to develop CKD prediction models using these ranked feature lists to identify the best performing top-ranked features combination. Finally, the most significant features were selected to develop a multivariate logistic regression-based CKD prediction model for T1DM patients. This model was evaluated using sensitivity, specificity, accuracy, precision, and F1 score on train and test data. A nomogram of the final model was further generated for easy application in clinical practices. Hypertension, duration of diabetes, drinking habit, triglycerides, ACE inhibitors, low-density lipoprotein (LDL) cholesterol, age, and smoking habit were the top-8 features ranked by the XGB model and identified as the most important features for predicting CKD in T1DM patients. These eight features were selected to develop the final prediction model using multivariate logistic regression, which showed 90.04% and 88.59% accuracy in internal and test data validation. The proposed model showed excellent performance and can be used for CKD identification in T1DM patients during routine checkups.
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9
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Xi X, Yin G, Wang X, Li X. Development and validation of a nomogram based on the hospital information system for quantitative assessment of the risk of cardiocerebrovascular complications of diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:675. [PMID: 35845535 PMCID: PMC9279809 DOI: 10.21037/atm-22-2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 11/11/2022]
Abstract
Background Although the prevention and treatment of the cardiocerebrovascular complications (CCVCs) of diabetes have been clarified, their incidence is still high. This is largely due to the lack of predictive models to objectively assess the risk of CCVC in patients with type 2 diabetes mellitus (T2DM), reducing their treatment adherence. Despite the fact that the risk factors of CCVC in T2DM patients have been identified, no prediction model for identifying T2DM patients with the risk of CCVC is available. Therefore, the aim of this study is to establish a nomogram based on hospital information system data to quantitatively assess the risk of CCVCs in T2DM patients. This model is contributed to individualized therapeutic treatments and motivating T2DM patients to adhere to lifestyle interventions. Methods The medical records of 1,556 T2DM patients, comprising 1,145 cases in the training cohort and 411 in the validation cohort were retrospectively analyzed. CCVCs of diabetes, including coronary heart disease, cerebral ischemia, and intracerebral hemorrhage, were extracted from the medical records. Univariate and multivariate logistic regression analyses were performed to screen the independent correlates of CCVCs from the demographic information and laboratory test data, which were utilized to establish a nomogram for predicting the risk of CCVCs in these patients. We used internal and external validation based on the training and validation cohorts to evaluate the model performance. Results The incidence of CCVCs in the training cohort (26.99%) was similar to the validation cohort (25.79%). Disease duration, body mass index (BMI), systolic blood pressure (SBP), glycosylated hemoglobin (HbA1c), and uric acid (UA) levels were finally included in the established nomogram. In both the internal and external validation, the nomogram showed good discrimination [area under the curve (AUC) =0.850 and 0.825, respectively] and calibration (P=0.127 and P=0.096, respectively). Decision curve analysis showed that the nomogram produced a net benefit in both the training and validation cohorts. Conclusions The nomogram developed for predicting the risk of CCVC in T2DM patients may help improve treatment adherence. Further multi-center prospective investigations are required to predict the timing of CVCC in T2DM patients.
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Affiliation(s)
- Xin Xi
- Information Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Guizhi Yin
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaoyong Wang
- Information Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Xuesong Li
- Department of Endocrinology, Minhang Hospital, Fudan University, Shanghai, China
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10
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Ren Q, Chen D, Liu X, Yang R, Yuan L, Ding M, Zhang N. Derivation and Validation of a Prediction Model of End-Stage Renal Disease in Patients With Type 2 Diabetes Based on a Systematic Review and Meta-analysis. Front Endocrinol (Lausanne) 2022; 13:825950. [PMID: 35360073 PMCID: PMC8960850 DOI: 10.3389/fendo.2022.825950] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To develop and validate a model for predicting the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes. METHODS The derivation cohort was from a meta-analysis. Statistically significant risk factors were extracted and combined to the corresponding risk ratio (RR) to establish a risk assessment model for ESRD in type 2 diabetes. All risk factors were scored according to their weightings to establish the prediction model. Model performance is evaluated using external validation cohorts. The outcome was the occurrence of ESRD defined as eGFR<15 ml min-1 1.73 m-2 or received kidney replacement therapy (dialysis or transplantation). RESULTS A total of 1,167,317 patients with type 2 diabetes were included in our meta-analysis, with a cumulative incidence of approximately 1.1%. The final risk factors of the prediction model included age, sex, smoking, diabetes mellitus (DM) duration, systolic blood pressure (SBP), hemoglobin A1c (HbA1c), estimated glomerular filtration rate (eGFR), and triglyceride (TG). All risk factors were scored according to their weightings, with the highest score being 36.5. External verification showed that the model has good discrimination, AUC=0.807(95%CI 0.753-0.861). The best cutoff value is 16 points, with the sensitivity and specificity given by 85.33% and 60.45%, respectively. CONCLUSION The study established a simple risk assessment model including 8 routinely available clinical parameters for predicting the risk of ESRD in type 2 diabetes.
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Affiliation(s)
- Qiuyue Ren
- Department of Nephropathy, Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Dong Chen
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinbang Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Ronglu Yang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lisha Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Min Ding
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Ning Zhang
- Department of Nephropathy, Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Ning Zhang,
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Wang H, Su X, Zhang QQ, Zhang YY, Chu ZY, Zhang JL, Ren Q. MicroRNA-93-5p participates in type 2 diabetic retinopathy through targeting Sirt1. Int Ophthalmol 2021; 41:3837-3848. [PMID: 34313929 DOI: 10.1007/s10792-021-01953-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the role of miR-93-5p in rats with type 2 diabetic retinopathy (DR) through targeting Sirt1. METHODS The targeting correlation between miR-93-5p and Sirt1 was validated by dual-luciferase reporter gene assay. Type 2 diabetes mellitus (T2DM) rat models were received intravitreal injection of antagomir NC (negative control), miR-93-5p antagomir, miR-93-5p agomir and/or recombinant Sirt1, followed by observation of pathological changes in retina via HE staining. Besides, retinal vascular permeability was determined by fluorescein isothiocyanate-bovine serum albumin (FITC-BSA), while the retinal vasculature was observed through retinal trypsin digestion. Expression of miR-93-5p and Sirt1 was measured by qRT-PCR and Western blotting, while the levels of VEGF, proinflammatory cytokines and anti-oxidative indicators were determined using corresponding kits. RESULTS MiR-93-5p could target Sirt1 as analyzed by the luciferase reporter gene assay. Rats in the T2DM group presented the up-regulation of miR-93-5p and down-regulation of Sirt1 in the retina, and miR-93-5p inhibition could up-regulate Sirt1 expression in the T2DM rats. Recombinant Sirt1 decreased retinal vascular permeability and acellular capillaries with improved pathological changes in retina from T2DM rats, which was abolished by miR-93-5p agomir. Moreover, miR-93-5p inhibition or Sirt1 overexpression decreased the levels of VEGF and proinflammatory cytokines while enhancing the activity of anti-oxidative indicators. However, indicators above had no significant differences between T2DM group and T2DM + agomir + Sirt1 group. CONCLUSION MiR-93-5p, via targeting Sirt1, could affect the vascular permeability and acellular capillaries and mitigate the inflammation and oxidative stress in the retinas, which may play a critical role in DR.
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Affiliation(s)
- Hui Wang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China
| | - Xian Su
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China
| | - Qian-Qian Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China
| | - Ying-Ying Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China
| | - Zhan-Ya Chu
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China
| | - Jin-Ling Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China
| | - Qian Ren
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Yuhua District, Shijiazhuang, 050030, Hebei Province, China.
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