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Lee H, Yoo G, Pak D, Lee JH. Evaluation of D-dimer and prothrombin time in alcohol related liver cirrhosis with comparison of machine learning analyses. Int J Med Inform 2024; 186:105407. [PMID: 38518675 DOI: 10.1016/j.ijmedinf.2024.105407] [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: 09/13/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Liver cirrhosis (LC) can be caused by obesity, alcohol consumption, viral infection, and autoimmune disease. Early diagnosis and management of LC is important for patient quality of life. Non-invasive diagnostic methods are useful for predicting the current status and mortality risk of LC. The purpose of this study is to identify relevant diagnostic factors measured in routine laboratory test of alcohol-related liver cirrhosis (ALC) patients. METHODS This study analyzed data from 127 patients with ALC, including their laboratory test results and clinical information, including coagulation parameters, hematologic parameters, and biochemical parameters. These data were used to compare the performance of the prediction models from three machine learning algorithms including K-nearest neighbor (KNN), support vector machine (SVM), and random forest (RF). RESULTS Higher Model for End-stage Liver Disease (MELD) score were associated with prothrombin time (PT) and D-dimer. Logistic and multiple linear regression analyses revealed significant factors predicting mortality in the MELD group. Machine learning approaches were used to predict death in ALC patients using some laboratory parameters associated with mortality. The prediction model based on SVM exhibited better prediction performance than others. CONCLUSION PT and D-dimer were the factors that were most strongly associated with 90-day mortality, and machine learning methods can create prediction models with good predictive power.
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Affiliation(s)
- Hyeongyu Lee
- Department of Laboratory Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Gilsung Yoo
- Department of Laboratory Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Daewoo Pak
- Division of Data Science, Yonsei University, Wonju, Republic of Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea.
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Zhang L, Huang Y, Huang M, Zhao CH, Zhang YJ, Wang Y. Development of Cost-Effective Fatty Liver Disease Prediction Models in a Chinese Population: Statistical and Machine Learning Approaches. JMIR Form Res 2024; 8:e53654. [PMID: 38363597 PMCID: PMC10907948 DOI: 10.2196/53654] [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: 10/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) in China presents a significant public health concern. Traditional ultrasound, commonly used for fatty liver screening, often lacks the ability to accurately quantify steatosis, leading to insufficient follow-up for patients with moderate-to-severe steatosis. Transient elastography (TE) provides a more quantitative diagnosis of steatosis and fibrosis, closely aligning with biopsy results. Moreover, machine learning (ML) technology holds promise for developing more precise diagnostic models for NAFLD using a variety of laboratory indicators. OBJECTIVE This study aims to develop a novel ML-based diagnostic model leveraging TE results for staging hepatic steatosis. The objective was to streamline the model's input features, creating a cost-effective and user-friendly tool to distinguish patients with NAFLD requiring follow-up. This innovative approach merges TE and ML to enhance diagnostic accuracy and efficiency in NAFLD assessment. METHODS The study involved a comprehensive analysis of health examination records from Suzhou Municipal Hospital, spanning from March to May 2023. Patient data and questionnaire responses were meticulously inputted into Microsoft Excel 2019, followed by thorough data cleaning and model development using Python 3.7, with libraries scikit-learn and numpy to ensure data accuracy. A cohort comprising 978 residents with complete medical records and TE results was included for analysis. Various classification models, including logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost), were constructed and evaluated based on the area under the receiver operating characteristic curve (AUROC). RESULTS Among the 916 patients included in the study, 273 were diagnosed with moderate-to-severe NAFLD. The concordance rate between traditional ultrasound and TE for detecting moderate-to-severe NAFLD was 84.6% (231/273). The AUROC values for the RF, LightGBM, XGBoost, SVM, KNN, and LR models were 0.91, 0.86, 0.83, 0.88, 0.77, and 0.81, respectively. These models achieved accuracy rates of 84%, 81%, 78%, 81%, 76%, and 77%, respectively. Notably, the RF model exhibited the best performance. A simplified RF model was developed with an AUROC of 0.88, featuring 62% sensitivity and 90% specificity. This simplified model used 6 key features: waist circumference, BMI, fasting plasma glucose, uric acid, total bilirubin, and high-sensitivity C-reactive protein. This approach offers a cost-effective and user-friendly tool while streamlining feature acquisition for training purposes. CONCLUSIONS The study introduces a groundbreaking, cost-effective ML algorithm that leverages health examination data for identifying moderate-to-severe NAFLD. This model has the potential to significantly impact public health by enabling targeted investigations and interventions for NAFLD. By integrating TE and ML technologies, the study showcases innovative approaches to advancing NAFLD diagnostics.
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Affiliation(s)
- Liang Zhang
- Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yueqing Huang
- Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Min Huang
- Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Chun-Hua Zhao
- Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yan-Jun Zhang
- School of Information Science and Engineering, Southeast University, Nanjing, China
| | - Yi Wang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, China
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Su PY, Chen YY, Lin CY, Su WW, Huang SP, Yen HH. Comparison of Machine Learning Models and the Fatty Liver Index in Predicting Lean Fatty Liver. Diagnostics (Basel) 2023; 13:diagnostics13081407. [PMID: 37189508 DOI: 10.3390/diagnostics13081407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
The reported prevalence of non-alcoholic fatty liver disease in studies of lean individuals ranges from 7.6% to 19.3%. The aim of the study was to develop machine-learning models for the prediction of fatty liver disease in lean individuals. The present retrospective study included 12,191 lean subjects with a body mass index < 23 kg/m2 who had undergone a health checkup from January 2009 to January 2019. Participants were divided into a training (70%, 8533 subjects) and a testing group (30%, 3568 subjects). A total of 27 clinical features were analyzed, except for medical history and history of alcohol or tobacco consumption. Among the 12,191 lean individuals included in the present study, 741 (6.1%) had fatty liver. The machine learning model comprising a two-class neural network using 10 features had the highest area under the receiver operating characteristic curve (AUROC) value (0.885) among all other algorithms. When applied to the testing group, we found the two-class neural network exhibited a slightly higher AUROC value for predicting fatty liver (0.868, 0.841-0.894) compared to the fatty liver index (FLI; 0.852, 0.824-0.81). In conclusion, the two-class neural network had greater predictive value for fatty liver than the FLI in lean individuals.
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Affiliation(s)
- Pei-Yuan Su
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 400, Taiwan
| | - Yang-Yuan Chen
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Hospitality Management, MingDao University, Changhua 500, Taiwan
| | - Chun-Yu Lin
- Department of Family Medicine, Yumin Hospital, Nantou 540, Taiwan
| | - Wei-Wen Su
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Siou-Ping Huang
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Hsu-Heng Yen
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 400, Taiwan
- General Education Center, Chienkuo Technology University, Changhua 500, Taiwan
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan 320, Taiwan
- Artificial Intelligence Development Center, Changhua Christian Hospital, Changhua 500, Taiwan
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Weng S, Hu D, Chen J, Yang Y, Peng D. Prediction of Fatty Liver Disease in a Chinese Population Using Machine-Learning Algorithms. Diagnostics (Basel) 2023; 13:diagnostics13061168. [PMID: 36980476 PMCID: PMC10047083 DOI: 10.3390/diagnostics13061168] [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: 02/19/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Fatty liver disease (FLD) is an important risk factor for liver cancer and cardiovascular disease and can lead to significant social and economic burden. However, there is currently no nationwide epidemiological survey for FLD in China, making early FLD screening crucial for the Chinese population. Unfortunately, liver biopsy and abdominal ultrasound, the preferred methods for FLD diagnosis, are not practical for primary medical institutions. Therefore, the aim of this study was to develop machine learning (ML) models for screening individuals at high risk of FLD, and to provide a new perspective on early FLD diagnosis. METHODS This study included a total of 30,574 individuals between the ages of 18 and 70 who completed abdominal ultrasound and the related clinical examinations. Among them, 3474 individuals were diagnosed with FLD by abdominal ultrasound. We used 11 indicators to build eight classification models to predict FLD. The model prediction ability was evaluated by the area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and kappa value. Feature importance analysis was assessed by Shapley value or root mean square error loss after permutations. RESULTS Among the eight ML models, the prediction accuracy of the extreme gradient boosting (XGBoost) model was highest at 89.77%. By feature importance analysis, we found that the body mass index, triglyceride, and alanine aminotransferase play important roles in FLD prediction. CONCLUSION XGBoost improves the efficiency and cost of large-scale FLD screening.
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Affiliation(s)
- Shuwei Weng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha 410011, China
| | - Die Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha 410011, China
| | - Jin Chen
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha 410011, China
| | - Yanyi Yang
- Health Management Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha 410011, China
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Martínez JA, Alonso-Bernáldez M, Martínez-Urbistondo D, Vargas-Nuñez JA, Ramírez de Molina A, Dávalos A, Ramos-Lopez O. Machine learning insights concerning inflammatory and liver-related risk comorbidities in non-communicable and viral diseases. World J Gastroenterol 2022; 28:6230-6248. [PMID: 36504554 PMCID: PMC9730439 DOI: 10.3748/wjg.v28.i44.6230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/07/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
The liver is a key organ involved in a wide range of functions, whose damage can lead to chronic liver disease (CLD). CLD accounts for more than two million deaths worldwide, becoming a social and economic burden for most countries. Among the different factors that can cause CLD, alcohol abuse, viruses, drug treatments, and unhealthy dietary patterns top the list. These conditions prompt and perpetuate an inflammatory environment and oxidative stress imbalance that favor the development of hepatic fibrogenesis. High stages of fibrosis can eventually lead to cirrhosis or hepatocellular carcinoma (HCC). Despite the advances achieved in this field, new approaches are needed for the prevention, diagnosis, treatment, and prognosis of CLD. In this context, the scientific com-munity is using machine learning (ML) algorithms to integrate and process vast amounts of data with unprecedented performance. ML techniques allow the integration of anthropometric, genetic, clinical, biochemical, dietary, lifestyle and omics data, giving new insights to tackle CLD and bringing personalized medicine a step closer. This review summarizes the investigations where ML techniques have been applied to study new approaches that could be used in inflammatory-related, hepatitis viruses-induced, and coronavirus disease 2019-induced liver damage and enlighten the factors involved in CLD development.
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Affiliation(s)
- J Alfredo Martínez
- Precision Nutrition and Cardiometabolic Health, Madrid Institute of Advanced Studies-Food Institute, Madrid 28049, Spain
| | - Marta Alonso-Bernáldez
- Precision Nutrition and Cardiometabolic Health, Madrid Institute of Advanced Studies-Food Institute, Madrid 28049, Spain
| | | | - Juan A Vargas-Nuñez
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Majadahonda, Spain
| | - Ana Ramírez de Molina
- Molecular Oncology and Nutritional Genomics of Cancer, Madrid Institute of Advanced Studies-Food Institute, Madrid 28049, Spain
| | - Alberto Dávalos
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute of Advanced Studies-Food Institute, Madrid 28049, Spain
| | - Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana 22390, Baja California, Mexico
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Carteri RB, Grellert M, Borba DL, Marroni CA, Fernandes SA. Machine learning approaches using blood biomarkers in non-alcoholic fatty liver diseases. Artif Intell Gastroenterol 2022; 3:80-87. [DOI: 10.35712/aig.v3.i3.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/15/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) is an important public health concern. Early diagnosis of NAFLD and potential progression to nonalcoholic steatohepatitis (NASH), could reduce the further advance of the disease, and improve patient outcomes. Aiming to support patient diagnostic and predict specific outcomes, the interest in artificial intelligence (AI) methods in hepatology has dramatically increased, especially with the application of less-invasive biomarkers. In this review, our objective was twofold: Firstly, we presented the most frequent blood biomarkers in NAFLD and NASH and secondly, we reviewed recent literature regarding the use of machine learning (ML) methods to predict NAFLD and NASH in large cohorts. Strikingly, these studies provide insights into ML application in NAFLD patients' prognostics and ranked blood biomarkers are able to provide a recognizable signature allowing cost-effective NAFLD prediction and also differentiating NASH patients. Future studies should consider the limitations in the current literature and expand the application of these algorithms in different populations, fortifying an already promising tool in medical science.
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Affiliation(s)
- Randhall B Carteri
- Department of Nutrition, Methodist University Center - IPA, Porto Alegre 90420-060, Rio Grande do Sul, Brazil
- Department of Health and Behaviour, Catholic University of Pelotas, Pelotas 96015-560, Rio Grande do Sul, Brazil
| | - Mateus Grellert
- Department of Informatics and Statistics, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - Daniela Luisa Borba
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Claudio Augusto Marroni
- Department of Gastroenterology and Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Sabrina Alves Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
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Machine-Learning Algorithm for Predicting Fatty Liver Disease in a Taiwanese Population. J Pers Med 2022; 12:jpm12071026. [PMID: 35887527 PMCID: PMC9317783 DOI: 10.3390/jpm12071026] [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: 05/22/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 12/04/2022] Open
Abstract
The rising incidence of fatty liver disease (FLD) poses a health challenge, and is expected to be the leading global cause of liver-related morbidity and mortality in the near future. Early case identification is crucial for disease intervention. A retrospective cross-sectional study was performed on 31,930 Taiwanese subjects (25,544 training and 6386 testing sets) who had received health check-ups and abdominal ultrasounds in Changhua Christian Hospital from January 2009 to January 2019. Clinical and laboratory factors were included for analysis by different machine-learning algorithms. In addition, the performance of the machine-learning algorithms was compared with that of the fatty liver index (FLI). Totally, 6658/25,544 (26.1%) and 1647/6386 (25.8%) subjects had moderate-to-severe liver disease in the training and testing sets, respectively. Five machine-learning models were examined and demonstrated exemplary performance in predicting FLD. Among these models, the xgBoost model revealed the highest area under the receiver operating characteristic (AUROC) (0.882), accuracy (0.833), F1 score (0.829), sensitivity (0.833), and specificity (0.683) compared with those of neural network, logistic regression, random forest, and support vector machine-learning models. The xgBoost, neural network, and logistic regression models had a significantly higher AUROC than that of FLI. Body mass index was the most important feature to predict FLD according to the feature ranking scores. The xgBoost model had the best overall prediction ability for diagnosing FLD in our study. Machine-learning algorithms provide considerable benefits for screening candidates with FLD.
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Mantovani A, Byrne CD, Targher G. Efficacy of peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 receptor agonists, or sodium-glucose cotransporter-2 inhibitors for treatment of non-alcoholic fatty liver disease: a systematic review. Lancet Gastroenterol Hepatol 2022; 7:367-378. [DOI: 10.1016/s2468-1253(21)00261-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022]
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