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Jin J, Lu J, Su X, Xiong Y, Ma S, Kong Y, Xu H. Development and Validation of an ICU-Venous Thromboembolism Prediction Model Using Machine Learning Approaches: A Multicenter Study. Int J Gen Med 2024; 17:3279-3292. [PMID: 39070227 PMCID: PMC11283785 DOI: 10.2147/ijgm.s467374] [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] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose The purpose of this study was to establish and validate machine learning-based models for predicting the risk of venous thromboembolism (VTE) in intensive care unit (ICU) patients. Patients and Methods The clinical data of 1494 ICU patients who underwent Doppler ultrasonography or venography between December 2020 and March 2023 were extracted from three tertiary hospitals. The Boruta algorithm was used to screen the essential variables associated with VTE. Five machine learning algorithms were employed: Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Gradient Boosting Decision Tree (GBDT), and Logistic Regression (LR). Hyperparameter optimization was conducted on the predictive model of the training dataset. The performance in the validation dataset was measured using indicators, including the area under curve (AUC) of the receiver operating characteristic (ROC) curve, specificity, and F1 score. Finally, the optimal model was interpreted using the SHapley Additive exPlanation (SHAP) package. Results The incidence of VTE among the ICU patients in this study was 26.04%. We screened 19 crucial features for the risk prediction model development. Among the five models, the RF model performed best, with an AUC of 0.788 (95% CI: 0.738-0.838), an accuracy of 0.759 (95% CI: 0.709-0.809), a sensitivity of 0.633, and a Brier score of 0.166. Conclusion A machine learning-based model for prediction of VTE in ICU patients were successfully developed, which could assist clinical medical staff in identifying high-risk populations for VTE in the early stages so that prevention measures can be implemented to reduce the burden on the ICU patients.
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Affiliation(s)
- Jie Jin
- School of Nursing, Binzhou Medical University, Binzhou, People’s Republic of China
| | - Jie Lu
- School of Nursing, Binzhou Medical University, Binzhou, People’s Republic of China
| | - Xinyang Su
- Department of Spine Surgery, Binzhou Medical University Hospital, Binzhou, People’s Republic of China
| | - Yinhuan Xiong
- Department of Nursing, Binzhou People’s Hospital, Binzhou, People’s Republic of China
| | - Shasha Ma
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, People’s Republic of China
| | - Yang Kong
- School of Health Management, Binzhou Medical University, Yantai, People’s Republic of China
| | - Hongmei Xu
- School of Nursing, Binzhou Medical University, Binzhou, People’s Republic of China
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Wei C, Wang J, Yu P, Li A, Xiong Z, Yuan Z, Yu L, Luo J. Comparison of different machine learning classification models for predicting deep vein thrombosis in lower extremity fractures. Sci Rep 2024; 14:6901. [PMID: 38519523 PMCID: PMC10960026 DOI: 10.1038/s41598-024-57711-w] [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: 09/06/2023] [Accepted: 03/21/2024] [Indexed: 03/25/2024] Open
Abstract
Deep vein thrombosis (DVT) is a common complication in patients with lower extremity fractures. Once it occurs, it will seriously affect the quality of life and postoperative recovery of patients. Therefore, early prediction and prevention of DVT can effectively improve the prognosis of patients. This study constructed different machine learning models to explore their effectiveness in predicting DVT. Five prediction models were applied to the study, including Extreme Gradient Boosting (XGBoost) model, Logistic Regression (LR) model, RandomForest (RF) model, Multilayer Perceptron (MLP) model, and Support Vector Machine (SVM) model. Afterwards, the performance of the obtained prediction models was evaluated by area under the curve (AUC), accuracy, sensitivity, specificity, F1 score, and Kappa. The prediction performances of the models based on machine learning are as follows: XGBoost model (AUC = 0.979, accuracy = 0.931), LR model (AUC = 0.821, accuracy = 0.758), RF model (AUC = 0.970, accuracy = 0.921), MLP model (AUC = 0.830, accuracy = 0.756), SVM model (AUC = 0.713, accuracy = 0.661). On our data set, the XGBoost model has the best performance. However, the model still needs external verification research before clinical application.
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Affiliation(s)
- Conghui Wei
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jialiang Wang
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Pengfei Yu
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Ang Li
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Ziying Xiong
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Zhen Yuan
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Lingling Yu
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.
| | - Jun Luo
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.
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Liu L, Li Y, Liu N, Luo J, Deng J, Peng W, Bai Y, Zhang G, Zhao G, Yang N, Li C, Long X. Establishment of machine learning-based tool for early detection of pulmonary embolism. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107977. [PMID: 38113803 DOI: 10.1016/j.cmpb.2023.107977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/11/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Pulmonary embolism (PE) is a complex disease with high mortality and morbidity rate, leading to increasing society burden. However, current diagnosis is solely based on symptoms and laboratory data despite its complex pathology, which easily leads to misdiagnosis and missed diagnosis by inexperienced doctors. Especially, CT pulmonary angiography, the gold standard method, is not widely available. In this study, we aim to establish a rapid and accurate screening model for pulmonary embolism using machine learning technology. Importantly, data required for disease prediction are easily accessed, including routine laboratory data and medical record information of patients. METHODS We extracted features from patients' routine laboratory results and medical records, including blood routine, biochemical group, blood coagulation routine and other test results, as well as symptoms and medical history information. Samples with a feature loss rate greater than 0.8 were deleted from the original database. Data from 4723 cases were retained, 231 of which were positive for pulmonary embolism. 50 features were retained through the positive and negative statistical hypothesis testing which was used to build the predictive model. In order to avoid identification as majority-class samples caused by the imbalance of sample proportion, we used the method of Synthetic Minority Oversampling Technique (SMOTE) to increase the amount of information on minority samples. Five typical machine learning algorithms were used to model the screening of pulmonary embolism, including Support Vector Machines, Logistic Regression, Random Forest, XGBoost, and Back Propagation Neural Networks. To evaluate model performance, sensitivity, specificity and AUC curve were analyzed as the main evaluation indicators. Furthermore, a baseline model was established using the characteristics of the pulmonary embolism guidelines as a comparison model. RESULTS We found that XGBoost showed better performance compared to other models, with the highest sensitivity and specificity (0.99 and 0.99, respectively). Moreover, it showed significant improvement in performance compared to the baseline model (sensitivity and specificity were 0.76 and 0.76 respectively). More important, our model showed low missed diagnosis rate (0.46) and high AUC value (0.992). Finally, the calculation time of our model is only about 0.05 s to obtain the possibility of pulmonary embolism. CONCLUSIONS In this study, five machine learning classification models were established to assess the likelihood of patients suffering from pulmonary embolism, and the XGBoost model most significantly improved the precision, sensitivity, and AUC for pulmonary embolism screening. Collectively, we have established an AI-based model to accurately predict pulmonary embolism at early stage.
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Affiliation(s)
- Lijue Liu
- School of Automation, Central South University, Changsha, Hunan 410083, China; Xiangjiang Laboratory, Changsha 410205, China; Hunan Zixing Intelligent Medical Technology Co., Ltd, Changsha, Hunan 410000, China
| | - Yaming Li
- School of Automation, Central South University, Changsha, Hunan 410083, China
| | - Na Liu
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
| | - Jingmin Luo
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
| | - Jinhai Deng
- Hunan Zixing Intelligent Medical Technology Co., Ltd, Changsha, Hunan 410000, China; Richard Dimbleby Laboratory of Cancer Research, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 1UL, UK
| | - Weixiong Peng
- Hunan Zixing Intelligent Medical Technology Co., Ltd, Changsha, Hunan 410000, China; Department of Electrical and Electronic Engineering, College of Engineering, Southern University of Science and Technology (SUSTech), Shenzhen, Guangdong 518055, China
| | - Yongping Bai
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Tongzipo Road 138#, Changsha 410008,China.
| | - Guihu Zhao
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
| | - Ning Yang
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
| | - Chuanchang Li
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
| | - Xueying Long
- Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha 410008, China
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Drăgan A, Drăgan AŞ. Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice. Cancers (Basel) 2024; 16:458. [PMID: 38275899 PMCID: PMC10813930 DOI: 10.3390/cancers16020458] [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: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Many cancer patients will experience venous thromboembolism (VTE) at some stage, with the highest rate in the initial period following diagnosis. Novel cancer therapies may further enhance the risk. VTE in a cancer setting is associated with poor prognostic, a decreased quality of life, and high healthcare costs. If thromboprophylaxis in hospitalized cancer patients and perioperative settings is widely accepted in clinical practice and supported by the guidelines, it is not the same situation in ambulatory cancer patient settings. The guidelines do not recommend primary thromboprophylaxis, except in high-risk cases. However, nowadays, risk stratification is still challenging, although many tools have been developed. The Khrorana score remains the most used method, but it has many limits. This narrative review aims to present the current relevant knowledge of VTE risk assessment in ambulatory cancer patients, starting from the guideline recommendations and continuing with the specific risk assessment methods and machine learning models approaches. Biomarkers, genetic, and clinical features were tested alone or in groups. Old and new models used in VTE risk assessment are exposed, underlining their clinical utility. Imaging and biomolecular approaches to VTE screening of outpatients with cancer are also presented, which could help clinical decisions.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Adrian Ştefan Drăgan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
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Chiasakul T, Lam BD, McNichol M, Robertson W, Rosovsky RP, Lake L, Vlachos IS, Adamski A, Reyes N, Abe K, Zwicker JI, Patell R. Artificial intelligence in the prediction of venous thromboembolism: A systematic review and pooled analysis. Eur J Haematol 2023; 111:951-962. [PMID: 37794526 PMCID: PMC10900245 DOI: 10.1111/ejh.14110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Accurate diagnostic and prognostic predictions of venous thromboembolism (VTE) are crucial for VTE management. Artificial intelligence (AI) enables autonomous identification of the most predictive patterns from large complex data. Although evidence regarding its performance in VTE prediction is emerging, a comprehensive analysis of performance is lacking. AIMS To systematically review the performance of AI in the diagnosis and prediction of VTE and compare it to clinical risk assessment models (RAMs) or logistic regression models. METHODS A systematic literature search was performed using PubMed, MEDLINE, EMBASE, and Web of Science from inception to April 20, 2021. Search terms included "artificial intelligence" and "venous thromboembolism." Eligible criteria were original studies evaluating AI in the prediction of VTE in adults and reporting one of the following outcomes: sensitivity, specificity, positive predictive value, negative predictive value, or area under receiver operating curve (AUC). Risks of bias were assessed using the PROBAST tool. Unpaired t-test was performed to compare the mean AUC from AI versus conventional methods (RAMs or logistic regression models). RESULTS A total of 20 studies were included. Number of participants ranged from 31 to 111 888. The AI-based models included artificial neural network (six studies), support vector machines (four studies), Bayesian methods (one study), super learner ensemble (one study), genetic programming (one study), unspecified machine learning models (two studies), and multiple machine learning models (five studies). Twelve studies (60%) had both training and testing cohorts. Among 14 studies (70%) where AUCs were reported, the mean AUC for AI versus conventional methods were 0.79 (95% CI: 0.74-0.85) versus 0.61 (95% CI: 0.54-0.68), respectively (p < .001). However, the good to excellent discriminative performance of AI methods is unlikely to be replicated when used in clinical practice, because most studies had high risk of bias due to missing data handling and outcome determination. CONCLUSION The use of AI appears to improve the accuracy of diagnostic and prognostic prediction of VTE over conventional risk models; however, there was a high risk of bias observed across studies. Future studies should focus on transparent reporting, external validation, and clinical application of these models.
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Affiliation(s)
- Thita Chiasakul
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology, Faculty of Medicine, Department of Medicine, Center of Excellence in Translational Hematology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Barbara D Lam
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McNichol
- Division of Knowledge Services, Department of Information Services (M.M.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - William Robertson
- National Blood Clot Alliance, Philadelphia, Pennsylvania, USA
- Department of Emergency Healthcare, College of Health Professions, Weber State University, Ogden, Utah, USA
| | - Rachel P Rosovsky
- Division of Hematology/Oncology, Department of Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie Lake
- National Blood Clot Alliance, Philadelphia, Pennsylvania, USA
| | - Ioannis S Vlachos
- Department of Pathology, Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alys Adamski
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nimia Reyes
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karon Abe
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey I Zwicker
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Rushad Patell
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ahmad RM, Ali BR, Al-Jasmi F, Sinnott RO, Al Dhaheri N, Mohamad MS. A review of genetic variant databases and machine learning tools for predicting the pathogenicity of breast cancer. Brief Bioinform 2023; 25:bbad479. [PMID: 38149678 PMCID: PMC10782903 DOI: 10.1093/bib/bbad479] [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: 06/22/2023] [Revised: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
Studies continue to uncover contributing risk factors for breast cancer (BC) development including genetic variants. Advances in machine learning and big data generated from genetic sequencing can now be used for predicting BC pathogenicity. However, it is unclear which tool developed for pathogenicity prediction is most suited for predicting the impact and pathogenicity of variant effects. A significant challenge is to determine the most suitable data source for each tool since different tools can yield different prediction results with different data inputs. To this end, this work reviews genetic variant databases and tools used specifically for the prediction of BC pathogenicity. We provide a description of existing genetic variants databases and, where appropriate, the diseases for which they have been established. Through example, we illustrate how they can be used for prediction of BC pathogenicity and discuss their associated advantages and disadvantages. We conclude that the tools that are specialized by training on multiple diverse datasets from different databases for the same disease have enhanced accuracy and specificity and are thereby more helpful to the clinicians in predicting and diagnosing BC as early as possible.
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Affiliation(s)
- Rahaf M Ahmad
- Health Data Science Lab, Department of Genetics and Genomics, College of Medical and Health Sciences, United Arab Emirates University, Tawam road, Al Maqam district, Al Ain, Abu Dhabi, United Arab Emirates
| | - Bassam R Ali
- Health Data Science Lab, Department of Genetics and Genomics, College of Medical and Health Sciences, United Arab Emirates University, Tawam road, Al Maqam district, Al Ain, Abu Dhabi, United Arab Emirates
| | - Fatma Al-Jasmi
- Health Data Science Lab, Department of Genetics and Genomics, College of Medical and Health Sciences, United Arab Emirates University, Tawam road, Al Maqam district, Al Ain, Abu Dhabi, United Arab Emirates
- Division of Metabolic Genetics, Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - Richard O Sinnott
- School of Computing and Information System, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Noura Al Dhaheri
- Health Data Science Lab, Department of Genetics and Genomics, College of Medical and Health Sciences, United Arab Emirates University, Tawam road, Al Maqam district, Al Ain, Abu Dhabi, United Arab Emirates
- Division of Metabolic Genetics, Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - Mohd Saberi Mohamad
- Health Data Science Lab, Department of Genetics and Genomics, College of Medical and Health Sciences, United Arab Emirates University, Tawam road, Al Maqam district, Al Ain, Abu Dhabi, United Arab Emirates
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Yang J, He J, Zhang H. Automating venous thromboembolism risk assessment: a dual-branch deep learning method using electronic medical records. Front Med (Lausanne) 2023; 10:1237616. [PMID: 37636570 PMCID: PMC10449249 DOI: 10.3389/fmed.2023.1237616] [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: 06/09/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a prevalent cardiovascular disease. Although risk assessment and preventive measures are effective, manual assessment is inefficient and covers a small population in clinical practice. Hence, it is necessary to explore intelligent methods for VTE risk assessment. Methods The Padua scale has been widely used in VTE risk assessment, and we divided its assessment into disease category judgment and comprehensive clinical information judgment according to the characteristics of the Padua scale. We proposed a dual-branch deep learning (DB-DL) assessment method. First, in the disease category branch, we propose a deep learning-based Padua disease classification model (PDCM) for determining patients' Padua disease categories by considering patients' diagnosis, symptoms, and symptom weights. In the branch of comprehensive clinical information, we use the Chinese lexical analysis (LAC) word separation technique, combined with professional corpus and rules, to extract and judge the comprehensive clinical factors in the electronic medical record (EMR). Results We validated the accuracy of the method with the Padua assessment results of 7,690 Chinese clinical EMRs. First, our proposed method allows for a fully automated assessment, and the average time to assess one patient is only 0.37 s. Compared to the gold standard, our method has an Area Under Curve (AUC) value of 0.883, a specificity value of 0.957, and a sensitivity value of 0.816 for assessing the Padua risk patient class. Conclusion Our DB-DL assessment method automates VTE risk assessment, thereby addressing the challenges of time-consuming evaluation and limited population coverage. Thus, this method is highly clinically valuable.
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Affiliation(s)
- Jianhua Yang
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
| | - Jianfeng He
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
| | - Hongjiang Zhang
- First People's Hospital of Anning City (Jinfang Branch), Anning, China
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Townsley SK, Basu D, Vora J, Wun T, Chuah C, Shankar PRV. Predicting venous thromboembolism (VTE) risk in cancer patients using machine learning. HEALTH CARE SCIENCE 2023; 2:205-222. [PMID: 38939521 PMCID: PMC11080820 DOI: 10.1002/hcs2.55] [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: 08/24/2022] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2024]
Abstract
Background The association between cancer and venous thromboembolism (VTE) is well-established with cancer patients accounting for approximately 20% of all VTE incidents. In this paper, we have performed a comparison of machine learning (ML) methods to traditional clinical scoring models for predicting the occurrence of VTE in a cancer patient population, identified important features (clinical biomarkers) for ML model predictions, and examined how different approaches to reducing the number of features used in the model impact model performance. Methods We have developed an ML pipeline including three separate feature selection processes and applied it to routine patient care data from the electronic health records of 1910 cancer patients at the University of California Davis Medical Center. Results Our ML-based prediction model achieved an area under the receiver operating characteristic curve of 0.778 ± 0.006 (mean ± SD) when trained on a set of 15 features. This result is comparable with the model performance when trained on all features in our feature pool [0.779 ± 0.006 (mean ± SD) with 29 features]. Our result surpasses the most validated clinical scoring system for VTE risk assessment in cancer patients by 16.1%. We additionally found cancer stage information to be a useful predictor after all performed feature selection processes despite not being used in existing score-based approaches. Conclusion From these findings, we observe that ML can offer new insights and a significant improvement over the most validated clinical VTE risk scoring systems in cancer patients. The results of this study also allowed us to draw insight into our feature pool and identify the features that could have the most utility in the context of developing an efficient ML classifier. While a model trained on our entire feature pool of 29 features significantly outperformed the traditionally used clinical scoring system, we were able to achieve an equivalent performance using a subset of only 15 features through strategic feature selection methods. These results are encouraging for potential applications of ML to predicting cancer-associated VTE in clinical settings such as in bedside decision support systems where feature availability may be limited.
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Affiliation(s)
- Samir Khan Townsley
- Department of Electrical and Computer EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Debraj Basu
- Department of Electrical and Computer EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Jayneel Vora
- Department of Computer ScienceUniversity of CaliforniaDavisCaliforniaUSA
| | - Ted Wun
- School of Medicine, Davis HealthUniversity of CaliforniaSacramentoCaliforniaUSA
| | - Chen‐Nee Chuah
- Department of Electrical and Computer EngineeringUniversity of CaliforniaDavisCaliforniaUSA
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Prediction of Hemorrhagic Complication after Thrombolytic Therapy Based on Multimodal Data from Multiple Centers: An Approach to Machine Learning and System Implementation. J Pers Med 2022; 12:jpm12122052. [PMID: 36556272 PMCID: PMC9782609 DOI: 10.3390/jpm12122052] [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: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Hemorrhagic complication (HC) is the most severe complication of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). This study aimed to build a machine learning (ML) prediction model and an application system for a personalized analysis of the risk of HC in patients undergoing IVT therapy. We included patients from Chongqing, Hainan and other centers, including Computed Tomography (CT) images, demographics, and other data, before the occurrence of HC. After feature engineering, a better feature subset was obtained, which was used to build a machine learning (ML) prediction model (Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), eXtreme Gradient Boosting (XGB)), and then evaluated with relevant indicators. Finally, a prediction model with better performance was obtained. Based on this, an application system was built using the Flask framework. A total of 517 patients were included, of which 332 were in the training cohort, 83 were in the internal validation cohort, and 102 were in the external validation cohort. After evaluation, the performance of the XGB model is better, with an AUC of 0.9454 and ACC of 0.8554 on the internal validation cohort, and 0.9142 and ACC of 0.8431 on the external validation cohort. A total of 18 features were used to construct the model, including hemoglobin and fasting blood sugar. Furthermore, the validity of the model is demonstrated through decision curves. Subsequently, a system prototype is developed to verify the test prediction effect. The clinical decision support system (CDSS) embedded with the XGB model based on clinical data and image features can better carry out personalized analysis of the risk of HC in intravenous injection patients.
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Ma H, Dong Z, Chen M, Sheng W, Li Y, Zhang W, Zhang S, Yu Y. A gradient boosting tree model for multi-department venous thromboembolism risk assessment with imbalanced data. J Biomed Inform 2022; 134:104210. [PMID: 36122879 DOI: 10.1016/j.jbi.2022.104210] [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: 12/30/2021] [Revised: 08/17/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022]
Abstract
Venous thromboembolism (VTE) is the world's third most common cause of vascular mortality and a serious complication from multiple departments. Risk assessment of VTE guides clinical intervention in time and is of great importance to in-hospital patients. Traditional VTE risk assessment methods based on scaling tools, which always require rules carefully designed by human experts, are difficult to apply to large-population scenarios since the manually designed rules are not guaranteed to be accurate to all populations. In contrast, with the development of the electronic health record (EHR) datasets, data-driven machine-learning-based risk assessment methods have proven superior predictability in many studies in recent years. This paper uses the gradient boosting tree model to study the VTE risk assessment problem with multi-department data. There exist two distinct characteristics of VTE data collected at the level of the entire hospital: its wide distribution and heterogeneity across multiple departments. To this end, we consider the prediction task over multiple departments as a multi-task learning process, and introduce the algorithm of a task-aware tree-based method TSGB to tackle the multi-task prediction problem. Although the introduction of multi-task learning improves overall across-department performance, we reveal the problem of task-wise performance decline while dealing with imbalanced VTE data volume. According to the analysis, we finally propose two variants of TSGB to alleviate the problems and further boost the prediction performance. Compared with state-of-the-art rule-based and multi-task tree-based methods, the experimental results show the proposed methods not only improve the overall across-department AUC performance effectively, but also ensure the improvement of performance over every single department prediction.
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Affiliation(s)
- Handong Ma
- Shanghai Jiao Tong University, Shanghai, China.
| | | | | | - Wenbo Sheng
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China.
| | - Yao Li
- Shanghai Jiao Tong University, Shanghai, China.
| | | | - Shaodian Zhang
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China; Shanghai Tenth People's Hospital, Shanghai, China.
| | - Yong Yu
- Shanghai Jiao Tong University, Shanghai, China.
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11
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Lei H, Zhang M, Wu Z, Liu C, Li X, Zhou W, Long B, Ma J, Zhang H, Wang Y, Wang G, Gong M, Hong N, Liu H, Wu Y. Development and Validation of a Risk Prediction Model for Venous Thromboembolism in Lung Cancer Patients Using Machine Learning. Front Cardiovasc Med 2022; 9:845210. [PMID: 35321110 PMCID: PMC8934875 DOI: 10.3389/fcvm.2022.845210] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThere is currently a lack of model for predicting the occurrence of venous thromboembolism (VTE) in patients with lung cancer. Machine learning (ML) techniques are being increasingly adapted for use in the medical field because of their capabilities of intelligent analysis and scalability. This study aimed to develop and validate ML models to predict the incidence of VTE among lung cancer patients.MethodsData of lung cancer patients from a Grade 3A cancer hospital in China with and without VTE were included. Patient characteristics and clinical predictors related to VTE were collected. The primary endpoint was the diagnosis of VTE during index hospitalization. We calculated and compared the area under the receiver operating characteristic curve (AUROC) using the selected best-performed model (Random Forest model) through multiple model comparison, as well as investigated feature contributions during the training process with both permutation importance scores and the impurity-based feature importance scores in random forest model.ResultsIn total, 3,398 patients were included in our study, 125 of whom experienced VTE during their hospital stay. The ROC curve and precision–recall curve (PRC) for Random Forest Model showed an AUROC of 0.91 (95% CI: 0.893–0.926) and an AUPRC of 0.43 (95% CI: 0.363–0.500). For the simplified model, five most relevant features were selected: Karnofsky Performance Status (KPS), a history of VTE, recombinant human endostatin, EGFR-TKI, and platelet count. We re-trained a random forest classifier with results of the AUROC of 0.87 (95% CI: 0.802–0.917) and AUPRC of 0.30 (95% CI: 0.265–0.358), respectively.ConclusionAccording to the study results, there was no conspicuous decrease in the model’s performance when use fewer features to predict, we concluded that our simplified model would be more applicable in real-life clinical settings. The developed model using ML algorithms in our study has the potential to improve the early detection and prediction of the incidence of VTE in patients with lung cancer.
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Affiliation(s)
- Haike Lei
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Mengyang Zhang
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Zeyi Wu
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Chun Liu
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Xiaosheng Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Wei Zhou
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Bo Long
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiayang Ma
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Huiyi Zhang
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Ying Wang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Guixue Wang
- MOE Key Laboratory for Biorheological Science and Technology, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering, Chongqing University, Chongqing, China
| | - Mengchun Gong
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Na Hong
- Digital Health China Technologies, Co., Ltd., Beijing, China
| | - Haixia Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
- *Correspondence: Haixia Liu,
| | - Yongzhong Wu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
- Yongzhong Wu,
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12
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Wang P, Wang Y, Yuan Z, Wang F, Wang H, Li Y, Wang C, Li L. Venous thromboembolism risk assessment of surgical patients in Southwest China using real-world data: establishment and evaluation of an improved venous thromboembolism risk model. BMC Med Inform Decis Mak 2022; 22:59. [PMID: 35246122 PMCID: PMC8895056 DOI: 10.1186/s12911-022-01795-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/01/2022] [Indexed: 12/20/2022] Open
Abstract
Background Venous thromboembolism (VTE) risk assessment in surgical patients is important for the appropriate diagnosis and treatment of patients. The commonly used Caprini model is limited by its inadequate ability to discriminate between risk stratums on the surgical population in southwest China and lengthy risk factors. The purpose of this study was to establish an improved VTE risk assessment model that is accurate and simple. Methods This study is based on the clinical data from 81,505 surgical patients hospitalized in the Southwest Hospital of China between January 1, 2019 and June 18, 2021. Among the population, 559 patients developed VTE. An improved VTE risk assessment model, SW-model, was established through Logistic Regression, with comparisons to both Caprini and Random Forest. Results The SW-model incorporated eight risk factors. The area under the curve (AUC) of SW-model (0.807 [0.758, 0.853], 0.804 [0.765, 0.840]), are significantly superior (p = 0.001 and p = 0.044) to those of the Caprini (0.705 [0.652, 0.757], 0.758 [0.719, 0795]) on two test sets, but inferior (p < 0.001 and p = 0.002) to Random Forest (0.854 [0.814, 0.890], 0.839 [0.806, 0.868]). In decision curve analysis, within threshold range from 0.015 to 0.04, the DCA curves of the SW-model are superior to Caprini and two default strategies. Conclusions The SW-model demonstrated a higher discriminative capability to distinguish VTE positive in surgical patients compared with the Caprini model. Compared to Random Forest, Logistic Regression based SW-model provided interpretability which is essential in guarantee the procedure of risk assessment transparent to clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01795-9.
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Affiliation(s)
- Peng Wang
- College of Computer Science, Chongqing University, Chongqing, China.,Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Yao Wang
- Yidu Cloud Technology Inc, Beijing, China
| | - Zhaoying Yuan
- Center for Applied Statistics and School of Statistics, Renmin University of China, Beijing, China
| | - Fei Wang
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Hongqian Wang
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Ying Li
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Chengliang Wang
- College of Computer Science, Chongqing University, Chongqing, China.
| | - Linfeng Li
- Yidu Cloud Technology Inc, Beijing, China.
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13
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Evaluation of Machine Learning Algorithms for Early Diagnosis of Deep Venous Thrombosis. MATHEMATICAL AND COMPUTATIONAL APPLICATIONS 2022. [DOI: 10.3390/mca27020024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Deep venous thrombosis (DVT) is a disease that must be diagnosed quickly, as it can trigger the death of patients. Nowadays, one can find different ways to determine it, including clinical scoring, D-dimer, ultrasonography, etc. Recently, scientists have focused efforts on using machine learning (ML) and neural networks for disease diagnosis, progressively increasing the accuracy and efficacy. Patients with suspected DVT have no apparent symptoms. Using pattern recognition techniques, aiding good timely diagnosis, as well as well-trained ML models help to make good decisions and validation. The aim of this paper is to propose several ML models for a more efficient and reliable DVT diagnosis through its implementation on an edge device for the development of instruments that are smart, portable, reliable, and cost-effective. The dataset was obtained from a state-of-the-art article. It is divided into 85% for training and cross-validation and 15% for testing. The input data in this study are the Wells criteria, the patient’s age, and the patient’s gender. The output data correspond to the patient’s diagnosis. This study includes the evaluation of several classifiers such as Decision Trees (DT), Extra Trees (ET), K-Nearest Neighbor (KNN), Multi-Layer Perceptron Neural Network (MLP-NN), Random Forest (RF), and Support Vector Machine (SVM). Finally, the implementation of these ML models on a high-performance embedded system is proposed to develop an intelligent system for early DVT diagnosis. It is reliable, portable, open source, and low cost. The performance of different ML algorithms was evaluated, where KNN achieved the highest accuracy of 90.4% and specificity of 80.66% implemented on personal computer (PC) and Raspberry Pi 4 (RPi4). The accuracy of all trained models on PC and Raspberry Pi 4 is greater than 85%, while the area under the curve (AUC) values are between 0.81 and 0.86. In conclusion, as compared to traditional methods, the best ML classifiers are effective at predicting DVT in an early and efficient manner.
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Jin S, Qin D, Liang BS, Zhang LC, Wei XX, Wang YJ, Zhuang B, Zhang T, Yang ZP, Cao YW, Jin SL, Yang P, Jiang B, Rao BQ, Shi HP, Lu Q. Machine learning predicts cancer-associated deep vein thrombosis using clinically available variables. Int J Med Inform 2022; 161:104733. [DOI: 10.1016/j.ijmedinf.2022.104733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022]
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15
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Koo J, Choi K, Lee P, Polley A, Pudupakam RS, Tsang J, Fernandez E, Han EJ, Park S, Swartzfager D, Qi NSX, Jung M, Ocnean M, Kim HU, Lim S. Predicting Dynamic Clinical Outcomes of the Chemotherapy for Canine Lymphoma Patients Using a Machine Learning Model. Vet Sci 2021; 8:vetsci8120301. [PMID: 34941828 PMCID: PMC8704313 DOI: 10.3390/vetsci8120301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
First-line treatments of cancer do not always work, and even when they do, they cure the disease at unequal rates mostly owing to biological and clinical heterogeneity across patients. Accurate prediction of clinical outcome and survival following the treatment can support and expedite the process of comparing alternative treatments. We describe the methodology to dynamically determine remission probabilities for individual patients, as well as their prospects of progression-free survival (PFS). The proposed methodology utilizes the ex vivo drug sensitivity of cancer cells, their immunophenotyping results, and patient information, such as age and breed, in training machine learning (ML) models, as well as the Cox hazards model to predict the probability of clinical remission (CR) or relapse across time for a given patient. We applied the methodology using the three types of data obtained from 242 canine lymphoma patients treated by (L)-CHOP chemotherapy. The results demonstrate substantial enhancement in the predictive accuracy of the ML models by utilizing features from all the three types of data. They also highlight superior performance and utility in predicting survival compared to the conventional stratification method. We believe that the proposed methodology can contribute to improving and personalizing the care of cancer patients.
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Affiliation(s)
- Jamin Koo
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
- ImpriMedKorea, Inc., Seoul Startup Hub, Seoul 04147, Korea;
- Department of Chemical Engineering, Hongik University, Seoul 04066, Korea
| | - Kyucheol Choi
- ImpriMedKorea, Inc., Seoul Startup Hub, Seoul 04147, Korea;
| | - Peter Lee
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Amanda Polley
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Raghavendra Sumanth Pudupakam
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Josephine Tsang
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Elmer Fernandez
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Enyang James Han
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Stanley Park
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Deanna Swartzfager
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Nicholas Seah Xi Qi
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Melody Jung
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Mary Ocnean
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
| | - Hyun Uk Kim
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea;
| | - Sungwon Lim
- ImpriMed, Inc., 4030 Fabian Way, Palo Alto, CA 94303, USA or (J.K.); (P.L.); (A.P.); (R.S.P.); (J.T.); (E.F.); (E.J.H.); (S.P.); (D.S.); (N.S.X.Q.); (M.J.); (M.O.)
- ImpriMedKorea, Inc., Seoul Startup Hub, Seoul 04147, Korea;
- Correspondence:
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Syrowatka A, Song W, Amato MG, Foer D, Edrees H, Co Z, Kuznetsova M, Dulgarian S, Seger DL, Simona A, Bain PA, Purcell Jackson G, Rhee K, Bates DW. Key use cases for artificial intelligence to reduce the frequency of adverse drug events: a scoping review. Lancet Digit Health 2021; 4:e137-e148. [PMID: 34836823 DOI: 10.1016/s2589-7500(21)00229-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/13/2021] [Accepted: 09/10/2021] [Indexed: 12/31/2022]
Abstract
Adverse drug events (ADEs) represent one of the most prevalent types of health-care-related harm, and there is substantial room for improvement in the way that they are currently predicted and detected. We conducted a scoping review to identify key use cases in which artificial intelligence (AI) could be leveraged to reduce the frequency of ADEs. We focused on modern machine learning techniques and natural language processing. 78 articles were included in the scoping review. Studies were heterogeneous and applied various AI techniques covering a wide range of medications and ADEs. We identified several key use cases in which AI could contribute to reducing the frequency and consequences of ADEs, through prediction to prevent ADEs and early detection to mitigate the effects. Most studies (73 [94%] of 78) assessed technical algorithm performance, and few studies evaluated the use of AI in clinical settings. Most articles (58 [74%] of 78) were published within the past 5 years, highlighting an emerging area of study. Availability of new types of data, such as genetic information, and access to unstructured clinical notes might further advance the field.
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Affiliation(s)
- Ania Syrowatka
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Wenyu Song
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mary G Amato
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Dinah Foer
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Heba Edrees
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Zoe Co
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sevan Dulgarian
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Diane L Seger
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Aurélien Simona
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, MA, USA
| | - Gretchen Purcell Jackson
- IBM Watson Health, Cambridge, MA, USA; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyu Rhee
- IBM Watson Health, Cambridge, MA, USA; CVS Health, Wellesley Hills, MA, USA
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
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Williams S, Layard Horsfall H, Funnell JP, Hanrahan JG, Khan DZ, Muirhead W, Stoyanov D, Marcus HJ. Artificial Intelligence in Brain Tumour Surgery-An Emerging Paradigm. Cancers (Basel) 2021; 13:cancers13195010. [PMID: 34638495 PMCID: PMC8508169 DOI: 10.3390/cancers13195010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 01/01/2023] Open
Abstract
Artificial intelligence (AI) platforms have the potential to cause a paradigm shift in brain tumour surgery. Brain tumour surgery augmented with AI can result in safer and more effective treatment. In this review article, we explore the current and future role of AI in patients undergoing brain tumour surgery, including aiding diagnosis, optimising the surgical plan, providing support during the operation, and better predicting the prognosis. Finally, we discuss barriers to the successful clinical implementation, the ethical concerns, and we provide our perspective on how the field could be advanced.
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Affiliation(s)
- Simon Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
- Correspondence:
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
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Hou L, Hu L, Gao W, Sheng W, Hao Z, Chen Y, Li J. Construction of a Risk Prediction Model for Hospital-Acquired Pulmonary Embolism in Hospitalized Patients. Clin Appl Thromb Hemost 2021; 27:10760296211040868. [PMID: 34558325 PMCID: PMC8495515 DOI: 10.1177/10760296211040868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study is to establish a novel pulmonary embolism (PE) risk
prediction model based on machine learning (ML) methods and to evaluate the
predictive performance of the model and the contribution of variables to the
predictive performance. We conducted a retrospective study at the Shanghai Tenth
People's Hospital and collected the clinical data of in-patients that received
pulmonary computed tomography imaging between January 1, 2014 and December 31,
2018. We trained several ML models, including logistic regression (LR), support
vector machine (SVM), random forest (RF), and gradient boosting decision tree
(GBDT), compared the models with representative baseline algorithms, and
investigated their predictability and feature interpretation. A total of 3619
patients were included in the study. We discovered that the GBDT model
demonstrated the best prediction with an area under the curve value of 0.799,
whereas those of the RF, LR, and SVM models were 0.791, 0.716, and 0.743,
respectively. The sensibilities of the GBDT, LR, RF, and SVM models were 63.9%,
68.1%, 71.5%, and 75%, respectively; the specificities were 81.1%, 66.1, 72.7%,
and 65.1%, respectively; and the accuracies were 77.8%, 66.5%, 72.5%, and 67%,
respectively. We discovered that the maximum D-dimer level contributed the most
to the outcome prediction, followed by the extreme growth rate of the plasma
fibrinogen level, in-hospital duration, and extreme growth rate of the D-dimer
level. The study demonstrates the superiority of the GBDT model in predicting
the risk of PE in hospitalized patients. However, in order to be applied in
clinical practice and provide support for clinical decision-making, the
predictive performance of the model needs to be prospectively verified.
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Affiliation(s)
- Lengchen Hou
- Shanghai Tenth People's Hospital, Shanghai, China.,*As co-first authors, the two authors have an equally important contribution to this research
| | - Longjun Hu
- Shanghai Tenth People's Hospital, Shanghai, China.,*As co-first authors, the two authors have an equally important contribution to this research
| | - Wenxue Gao
- Shanghai Tenth People's Hospital, Shanghai, China
| | - Wenbo Sheng
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Zedong Hao
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Jiyu Li
- Shanghai Tenth People's Hospital, Shanghai, China
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19
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Grothen AE, Tennant B, Wang C, Torres A, Bloodgood Sheppard B, Abastillas G, Matatova M, Warner JL, Rivera DR. Application of Artificial Intelligence Methods to Pharmacy Data for Cancer Surveillance and Epidemiology Research: A Systematic Review. JCO Clin Cancer Inform 2021; 4:1051-1058. [PMID: 33197205 DOI: 10.1200/cci.20.00101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The implementation and utilization of electronic health records is generating a large volume and variety of data, which are difficult to process using traditional techniques. However, these data could help answer important questions in cancer surveillance and epidemiology research. Artificial intelligence (AI) data processing methods are capable of evaluating large volumes of data, yet current literature on their use in this context of pharmacy informatics is not well characterized. METHODS A systematic literature review was conducted to evaluate relevant publications within four domains (cancer, pharmacy, AI methods, population science) across PubMed, EMBASE, Scopus, and the Cochrane Library and included all publications indexed between July 17, 2008, and December 31, 2018. The search returned 3,271 publications, which were evaluated for inclusion. RESULTS There were 36 studies that met criteria for full-text abstraction. Of those, only 45% specifically identified the pharmacy data source, and 55% specified drug agents or drug classes. Multiple AI methods were used; 25% used machine learning (ML), 67% used natural language processing (NLP), and 8% combined ML and NLP. CONCLUSION This review demonstrates that the application of AI data methods for pharmacy informatics and cancer epidemiology research is expanding. However, the data sources and representations are often missing, challenging study replicability. In addition, there is no consistent format for reporting results, and one of the preferred metrics, F-score, is often missing. There is a resultant need for greater transparency of original data sources and performance of AI methods with pharmacy data to improve the translation of these results into meaningful outcomes.
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Affiliation(s)
- Andrew E Grothen
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Catherine Wang
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | | | | | - Marina Matatova
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Donna R Rivera
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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20
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A novel hierarchical machine learning model for hospital-acquired venous thromboembolism risk assessment among multiple-departments. J Biomed Inform 2021; 122:103892. [PMID: 34454079 DOI: 10.1016/j.jbi.2021.103892] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022]
Abstract
Venous thromboembolism (VTE) is a common vascular disease and potentially fatal complication during hospitalization, and so the early identification of VTE risk is of significant importance. Compared with traditional scale assessments, machine learning methods provide new opportunities for precise early warning of VTE from clinical medical records. This research aimed to propose a two-stage hierarchical machine learning model for VTE risk prediction in patients from multiple departments. First, we built a machine learning prediction model that covered the entire hospital, based on all cohorts and common risk factors. Then, we took the prediction output of the first stage as an initial assessment score and then built specific models for each department. Over the duration of the study, a total of 9213 inpatients, including 1165 VTE-positive samples, were collected from four departments, which were split into developing and test datasets. The proposed model achieved an AUC of 0.879 in the department of oncology, which outperformed the first-stage model (0.730) and the department model (0.787). This was attributed to the fully usage of both the large sample size at the hospital level and variable abundance at the department level. Experimental results show that our model could effectively improve the prediction of hospital-acquired VTE risk before image diagnosis and provide decision support for further nursing and medical intervention.
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21
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Luo L, Kou R, Feng Y, Xiang J, Zhu W. Cost-Effective Machine Learning Based Clinical Pre-Test Probability Strategy for DVT Diagnosis in Neurological Intensive Care Unit. Clin Appl Thromb Hemost 2021; 27:10760296211008650. [PMID: 33928796 PMCID: PMC8114755 DOI: 10.1177/10760296211008650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In order to overcome the shortage of the current costly DVT diagnosis and reduce the waste of valuable healthcare resources, we proposed a new diagnostic approach based on machine learning pre-test prediction models using EHRs. We examined the sociodemographic and clinical factors in the prediction of DVT with 518 NICU admitted patients, including 189 patients who eventually developed DVT. We used cross-validation on the training data to determine the optimal parameters, and finally, the applied ROC analysis is adopted to evaluate the predictive strength of each model. Two models (GLM and SVM) with the strongest ROC were selected for DVT prediction, based on which, we optimized the current intervention and diagnostic process of DVT and examined the performance of the proposed approach through simulations. The use of machine learning based pre-test prediction models can simplify and improve the intervention and diagnostic process of patients in NICU with suspected DVT, and reduce the valuable healthcare resource occupation/usage and medical costs.
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Affiliation(s)
- Li Luo
- 533694Business School, Sichuan University, Chengdu, China
| | - Ran Kou
- 533694Business School, Sichuan University, Chengdu, China
| | - Yuquan Feng
- 533694Business School, Sichuan University, Chengdu, China
| | - Jie Xiang
- 533694Business School, Sichuan University, Chengdu, China
| | - Wei Zhu
- 439679West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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22
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The potential of artificial intelligence to improve patient safety: a scoping review. NPJ Digit Med 2021; 4:54. [PMID: 33742085 PMCID: PMC7979747 DOI: 10.1038/s41746-021-00423-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI) represents a valuable tool that could be used to improve the safety of care. Major adverse events in healthcare include: healthcare-associated infections, adverse drug events, venous thromboembolism, surgical complications, pressure ulcers, falls, decompensation, and diagnostic errors. The objective of this scoping review was to summarize the relevant literature and evaluate the potential of AI to improve patient safety in these eight harm domains. A structured search was used to query MEDLINE for relevant articles. The scoping review identified studies that described the application of AI for prediction, prevention, or early detection of adverse events in each of the harm domains. The AI literature was narratively synthesized for each domain, and findings were considered in the context of incidence, cost, and preventability to make projections about the likelihood of AI improving safety. Three-hundred and ninety-two studies were included in the scoping review. The literature provided numerous examples of how AI has been applied within each of the eight harm domains using various techniques. The most common novel data were collected using different types of sensing technologies: vital sign monitoring, wearables, pressure sensors, and computer vision. There are significant opportunities to leverage AI and novel data sources to reduce the frequency of harm across all domains. We expect AI to have the greatest impact in areas where current strategies are not effective, and integration and complex analysis of novel, unstructured data are necessary to make accurate predictions; this applies specifically to adverse drug events, decompensation, and diagnostic errors.
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23
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Blockchain and IoT Convergence—A Systematic Survey on Technologies, Protocols and Security. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Internet of Things (IoT) as a concept is fascinating and exciting, with an exponential growth just beginning. The IoT global market is expected to grow from 170 billion USD in 2017 to 560 billion USD by 2022. Though many experts have pegged IoT as the next industrial revolution, two of the major challenging aspects of IoT since the early days are having a secure privacy-safe ecosystem encompassing all building blocks of IoT architecture and solve the scalability problem as the number of devices increases. In recent years, Distributed Ledgers have often been referred to as the solution for both privacy and security problems. One form of distributed ledger is the Blockchain system. The aim of this paper consists of reviewing the most recent Blockchain architectures, comparing the most interesting and popular consensus algorithms, and evaluating the convergence between Blockchain and IoT by illustrating some of the main interesting projects in this research field. Furthermore, the paper provides a vision of a disruptive research topic that the authors are investigating: the use of AI algorithms to be applied to IoT devices belonging to a Blockchain architecture. This obviously requires that the devices be provided with adequate computational capacity and that can efficiently optimize their energy consumption.
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24
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Gökçe AB, Eren B, Sağır D, Demirel Yılmaz B. A histopathological and stereological study of the effects of acetylsalicylic acid on doxorubicin-induced hepatotoxicity in mice. Biotech Histochem 2020; 96:251-256. [PMID: 32643434 DOI: 10.1080/10520295.2020.1788724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Doxorubicin (Dox) is an anthracycline antibiotic with antineoplastic activity. Acetylsalicylic acid (Asa) is recommended for use as a prophylactic for thromboembolism during treatment of cancers. We investigated liver toxicity due to combined use of Dox and Asa in chemotherapy regimens. We used 140 Swiss albino mice divided into four main groups: control, Dox, Asa, and Dox + Asa. Each group was subdivided into seven subgroups based on time of sacrifice, i.e., 6, 12, 24, 48 h and 7, 14, 21 days. Quantitative and histopathological changes in liver were assessed by light microscopy and stereology. The portal triad area of the Dox and Dox + Asa groups was increased significantly compared to controls at 6 h, whereas in the Asa group, the means were similar to controls. Assessment of histopathology indicated an increased time-dependent degeneration and necrosis of liver tissues in mice in the Dox and Dox + Asa groups. The protective effects of Asa were not evident in Dox + Asa group. When Dox and Asa were administered together, degenerative changes were greater than for in the group that was given Dox alone. We found that Asa and Dox combined therapy increased tissue damage.
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Affiliation(s)
- Ayşe Başardı Gökçe
- Department of Biology, Ondokuz Mayıs University Faculty of Arts and Science, Samsun, Turkey
| | - Banu Eren
- Department of Biology, Ondokuz Mayıs University Faculty of Arts and Science, Samsun, Turkey
| | - Dilek Sağır
- Faculty of Health Sciences, Nursing Department, Sinop University, Sinop, Turkey
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25
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Ferroni P, Zanzotto FM, Scarpato N, Spila A, Fofi L, Egeo G, Rullo A, Palmirotta R, Barbanti P, Guadagni F. Machine learning approach to predict medication overuse in migraine patients. Comput Struct Biotechnol J 2020; 18:1487-1496. [PMID: 32637046 PMCID: PMC7327028 DOI: 10.1016/j.csbj.2020.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022] Open
Abstract
Machine learning (ML) is largely used to develop automatic predictors in migraine classification but automatic predictors for medication overuse (MO) in migraine are still in their infancy. Thus, to understand the benefits of ML in MO prediction, we explored an automated predictor to estimate MO risk in migraine. To achieve this objective, a study was designed to analyze the performance of a customized ML-based decision support system that combines support vector machines and Random Optimization (RO-MO). We used RO-MO to extract prognostic information from demographic, clinical and biochemical data. Using a dataset of 777 consecutive migraine patients we derived a set of predictors with discriminatory power for MO higher than that observed for baseline SVM. The best four were incorporated into the final RO-MO decision support system and risk evaluation on a five-level stratification was performed. ROC analysis resulted in a c-statistic of 0.83 with a sensitivity and specificity of 0.69 and 0.87, respectively, and an accuracy of 0.87 when MO was predicted by at least three RO-MO models. Logistic regression analysis confirmed that the derived RO-MO system could effectively predict MO with ORs of 5.7 and 21.0 for patients classified as probably (3 predictors positive), or definitely at risk of MO (4 predictors positive), respectively. In conclusion, a combination of ML and RO - taking into consideration clinical/biochemical features, drug exposure and lifestyle - might represent a valuable approach to MO prediction in migraine and holds the potential for improving model precision through weighting the relative importance of attributes.
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Key Words
- AI, Artificial Intelligence
- AUC, Area Under the Curve
- Artificial intelligence
- BMI, body mass index
- CI, Confidence Interval
- DBH 19-bp I/D polymorphism, Dopamine-Beta-Hydroxylase 19 bp insertion/deletion polymorphism
- DSS, Decision Support System
- Decision support systems
- ICT, Information and Communications Technology
- KELP, Kernel-based Learning Platform
- LRs, likelihood ratios
- MKL, Multiple Kernel Learning
- ML, Machine Learning
- MO, Medication Overuse
- Machine learning
- Medication overuse
- Migraine
- NSAID, nonsteroidal anti-inflammatory drugs
- PVI, Predictive Value Imputation
- RO, Random Optimization
- ROC, Receiver operating characteristic
- SE, Standard Error
- SVM, Support Vector Machine
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Affiliation(s)
- Patrizia Ferroni
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Fabio M. Zanzotto
- Department of Enterprise Engineering, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Noemi Scarpato
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Antonella Spila
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Luisa Fofi
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Gabriella Egeo
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Alessandro Rullo
- Neatec S.p.A., Via Campi Flegrei, 34, 80078 Pozzuoli, Naples, Italy
| | - Raffaele Palmirotta
- Department of Biomedical Sciences & Human Oncology, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Piero Barbanti
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Fiorella Guadagni
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
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26
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Venous Thromboembolism in Cancer Patients on Simultaneous and Palliative Care. Cancers (Basel) 2020; 12:cancers12051167. [PMID: 32384641 PMCID: PMC7281278 DOI: 10.3390/cancers12051167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/25/2022] Open
Abstract
Simultaneous care represents the ideal integration between early supportive and palliative care in cancer patients under active antineoplastic treatment. Cancer patients require a composite clinical, social and psychological management that can be effective only if care continuity from hospital to home is guaranteed and if such a care takes place early in the course of the disease, combining standard oncology care and palliative care. In these settings, venous thromboembolism (VTE) represents a difficult medical challenge, for the requirement of acute treatments and for the strong impact on anticancer therapies that might be delayed or, even, totally discontinued. Moreover, cancer patients not only display high rates of VTE occurrence/recurrence but are also more prone to bleeding and this forces clinicians to optimize treatment strategies, balancing between hemorrhages and thrombus formation. VTE prevention is, therefore, regarded as a double-edged sword. Indeed, while on one hand the appropriate use of antithrombotic agents can reduce VTE occurrence, on the other it significantly increases the bleeding risk, especially in the frail patients who present with multiple co-morbidities and poly-therapy that can interact with anticoagulant drugs. For these reasons, thromboprophylaxis should start while active cancer treatment is ongoing, according to a simultaneous care model in a patient-centered perspective.
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27
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Wang X, Yang YQ, Liu SH, Hong XY, Sun XF, Shi JH. Comparing different venous thromboembolism risk assessment machine learning models in Chinese patients. J Eval Clin Pract 2020; 26:26-34. [PMID: 31840330 DOI: 10.1111/jep.13324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is a fatal complication and the most common preventable cause of death in hospitals. The risk-to-benefit ratio of thromboprophylaxis depends on the performance of the risk assessment model. A linear model, the Padua model, is recommended for medical inpatients in the United States but is not suitable for Chinese inpatients due to differences in race and disease spectrum. Currently, machine learning (ML) methods show advantages in modeling complex data patterns and have been applied to clinical data analysis. This study aimed to build VTE risk assessment ML models among Chinese inpatients and compare the predictive validity of the ML models with that of the Padua model. METHODS We used 376 patients, including 188 patients with VTE, to build a model and then evaluate the predictive validity of the model in a consecutive clinical dataset from Peking Union Medical College Hospital. Nine widely used ML methods were trained on the model derivation set and then compared with the Padua model. RESULTS Among the nine ML methods, random forest (RF), boosting-based methods, and logistic regression achieved a higher specificity, Youden index, positive predictive value, and area under the receiver operating characteristic curve than the Padua model on both the test and clinical validation sets. However, their sensitivities were inferior to that of the Padua model. Combined with the receiver operating characteristic curve, RF, as the best performing model, maintained high specificity with relatively better sensitivity and captured VTE patients' patterns more precisely. CONCLUSIONS Advances in ML technology provide powerful tools for medical data analysis, and choosing models conforming to the disease pattern would achieve good performance. Popular ML models do not surpass the Padua model on all indicators of validity, and the drawback of low sensitivity should be improved upon in the future.
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Affiliation(s)
- Xin Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yu-Qing Yang
- Computer Science and Technology, Tsinghua University, Beijing, China
| | - Si-Hua Liu
- Department of Respiration, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xin-Yu Hong
- Department of Respiration, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xue-Feng Sun
- Department of Respiration, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ju-Hong Shi
- Department of Respiration, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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28
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Tavares V, Pinto R, Assis J, Pereira D, Medeiros R. Venous thromboembolism GWAS reported genetic makeup and the hallmarks of cancer: Linkage to ovarian tumour behaviour. Biochim Biophys Acta Rev Cancer 2020; 1873:188331. [DOI: 10.1016/j.bbcan.2019.188331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 12/14/2022]
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29
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Yang Y, Wang X, Huang Y, Chen N, Shi J, Chen T. Ontology-based venous thromboembolism risk assessment model developing from medical records. BMC Med Inform Decis Mak 2019; 19:151. [PMID: 31391095 PMCID: PMC6686216 DOI: 10.1186/s12911-019-0856-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Padua linear model is widely used for the risk assessment of venous thromboembolism (VTE), a common but preventable complication for inpatients. However, genetic and environmental differences between Western and Chinese population limit the validity of Padua model in Chinese patients. Medical records which contain rich information about disease progression, are useful in mining new risk factors related to Chinese VTE patients. Furthermore, machine learning (ML) methods provide new opportunities to build precise risk prediction model by automatic selection of risk factors based on original medical records. METHODS Medical records of 3,106 inpatients including 224 VTE patients were collected and various types of ontologies were integrated to parse unstructured text. A workflow of ontology-based VTE risk prediction model, that combines natural language processing (NLP) and machine learning (ML) technologies, was proposed. Firstly ontology terms were extracted from medical records, then sorted according to their calculated weights. Next importance of each term in the unit of section was evaluated and finally a ML model was built based on a subset of terms. Four ML methods were tested, and the best model was decided by comparing area under the receiver operating characteristic curve (AUROC). RESULTS Medical records were first split into different sections and subsequently, terms from each section were sorted by their weights calculated by multiple types of information. Greedy selection algorithm was used to obtain significant sections and terms. Top terms in each section were selected to construct patients' distributed representations by word embedding technique. Using top 300 terms of two important sections, namely the 'Progress Note' section and 'Admitting Diagnosis' section, the model showed relatively better predictive performance. Then ML model which utilizes a subset of terms from two sections, about 110 terms, achieved the best AUC score, of 0.973 ± 0.006, which was significantly better compared to the Padua's performance of 0.791 ± 0.022. Terms found by the model showed their potential to help clinicians explore new risk factors. CONCLUSIONS In this study, a new VTE risk assessment model based on ontologies extraction from raw medical records is developed and its performance is verified on real clinical dataset. Results of selected terms can help clinicians to discover meaningful risk factors.
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Affiliation(s)
- Yuqing Yang
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Xin Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Yu Huang
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Ning Chen
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Juhong Shi
- Peking Union Medical College, Beijing, China.
- Department of Respiration, Peking Union Medical College Hospital, Beijing, China.
| | - Ting Chen
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China.
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China.
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30
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Ferroni P. Meet Our Section Editor. Curr Med Chem 2019. [DOI: 10.2174/092986732603190326151204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Breast Cancer Prognosis Using a Machine Learning Approach. Cancers (Basel) 2019; 11:cancers11030328. [PMID: 30866535 PMCID: PMC6468737 DOI: 10.3390/cancers11030328] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 12/30/2022] Open
Abstract
Machine learning (ML) has been recently introduced to develop prognostic classification models that can be used to predict outcomes in individual cancer patients. Here, we report the significance of an ML-based decision support system (DSS), combined with random optimization (RO), to extract prognostic information from routinely collected demographic, clinical and biochemical data of breast cancer (BC) patients. A DSS model was developed in a training set (n = 318), whose performance analysis in the testing set (n = 136) resulted in a C-index for progression-free survival of 0.84, with an accuracy of 86%. Furthermore, the model was capable of stratifying the testing set into two groups of patients with low- or high-risk of progression with a hazard ratio (HR) of 10.9 (p < 0.0001). Validation in multicenter prospective studies and appropriate management of privacy issues in relation to digital electronic health records (EHR) data are presently needed. Nonetheless, we may conclude that the implementation of ML algorithms and RO models into EHR data might help to achieve prognostic information, and has the potential to revolutionize the practice of personalized medicine.
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von Hagens C, Walter-Sack I, Goeckenjan M, Storch-Hagenlocher B, Sertel S, Elsässer M, Remppis BA, Munzinger J, Edler L, Efferth T, Schneeweiss A, Strowitzki T. Long-term add-on therapy (compassionate use) with oral artesunate in patients with metastatic breast cancer after participating in a phase I study (ARTIC M33/2). PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 54:140-148. [PMID: 30668363 DOI: 10.1016/j.phymed.2018.09.178] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/17/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The antimalarial artesunate (ART), a semisynthetic derivative of artemisinin from the Chinese herb artemisia annua has remarkable anticancer properties in vitro and in vivo. Its excellent safety profile known from short-term therapy in malaria was confirmed in an open phase I trial (ARTIC M33/2) for dose-finding as add-on therapy for four weeks. PURPOSE Patients with metastatic breast cancer, who had not experienced any clinically relevant adverse events (AE) during participation in ARTIC M33/2, were offered to continue ART as compassionate use (CU). Regular monitoring was continued in order to ensure adequate individual safety and tolerability and to collect information about long-term treatment with ART. Clinically relevant AEs or second progression of disease during ART were reasons for discontinuation of the add-on therapy. STUDY DESIGN Compassionate use was offered open-label to participants of ARTIC M33/2. METHODS Patients continued to take 100, 150 or 200 mg oral ART daily as add-on therapy to their guideline-based oncological therapy. Clinical and laboratory monitoring included audiological and neurological examination, ECG, NTproBNP and reticulocyte determination. Cumulative treatment days and cumulative ART doses encompass both the phase I study as well as the continued add-on treatment period (CU). RESULTS Following the 4 ± 1 weeks of the phase I trial, thirteen patients continued the add-on therapy as CU, resulting in a total of 3825 treatment days. In individual patients up to 1115 cumulative treatment days (37 months) and cumulative ART doses up to 167.3 g were reached. A total of 25 AEs grade ≥ 2 at least possibly related to ART long-term add-on therapy were documented, two, six and 17 in dose groups 100, 150 and 200 mg/d ART respectively. Six of these AEs were classified as grade 3, two in patients taking 150 and four in patients on 200 mg/d, none of them being probably or certainly related to ART. CONCLUSIONS In thirteen patients with metastatic breast cancer up to 200 mg/d long-term oral ART (2.3-4.1 mg/kg BW/d) in up to 1115 cumulative treatment days (37 months) did not result in any major safety concerns.
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Affiliation(s)
- Cornelia von Hagens
- Naturopathy and Integrative Medicine, Department of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Heidelberg, Germany.
| | - Ingeborg Walter-Sack
- Clinical Pharmacology and Pharmacoepidemiology, University Hospital, Heidelberg, Germany
| | - Maren Goeckenjan
- Naturopathy and Integrative Medicine, Department of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Heidelberg, Germany
| | | | - Serkan Sertel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Heidelberg, Germany
| | | | - Bjoern A Remppis
- Department of Cardiology, University Hospital, Heidelberg, Germany
| | - Judith Munzinger
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Lutz Edler
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Thomas Efferth
- Pharmaceutical Biology of Natural Products (C015), German Cancer Research Center, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Naturopathy and Integrative Medicine, Department of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Heidelberg, Germany
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Riondino S, Ferroni P, Zanzotto FM, Roselli M, Guadagni F. Predicting VTE in Cancer Patients: Candidate Biomarkers and Risk Assessment Models. Cancers (Basel) 2019; 11:cancers11010095. [PMID: 30650562 PMCID: PMC6356247 DOI: 10.3390/cancers11010095] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023] Open
Abstract
Risk prediction of chemotherapy-associated venous thromboembolism (VTE) is a compelling challenge in contemporary oncology, as VTE may result in treatment delays, impaired quality of life, and increased mortality. Current guidelines do not recommend thromboprophylaxis for primary prevention, but assessment of the patient's individual risk of VTE prior to chemotherapy is generally advocated. In recent years, efforts have been devoted to building accurate predictive tools for VTE risk assessment in cancer patients. This review focuses on candidate biomarkers and prediction models currently under investigation, considering their advantages and disadvantages, and discussing their diagnostic performance and potential pitfalls.
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Affiliation(s)
- Silvia Riondino
- Interinstitutional Multidisciplinary Biobank, IRCCS San Raffaele Pisana, 00166 Rome, Italy.
- Department of Systems Medicine, Medical Oncology, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Patrizia Ferroni
- Interinstitutional Multidisciplinary Biobank, IRCCS San Raffaele Pisana, 00166 Rome, Italy.
- Department of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, 00166 Rome, Italy.
| | - Fabio Massimo Zanzotto
- Department of Enterprise Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Fiorella Guadagni
- Interinstitutional Multidisciplinary Biobank, IRCCS San Raffaele Pisana, 00166 Rome, Italy.
- Department of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, 00166 Rome, Italy.
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van Os HJA, Ramos LA, Hilbert A, van Leeuwen M, van Walderveen MAA, Kruyt ND, Dippel DWJ, Steyerberg EW, van der Schaaf IC, Lingsma HF, Schonewille WJ, Majoie CBLM, Olabarriaga SD, Zwinderman KH, Venema E, Marquering HA, Wermer MJH. Predicting Outcome of Endovascular Treatment for Acute Ischemic Stroke: Potential Value of Machine Learning Algorithms. Front Neurol 2018; 9:784. [PMID: 30319525 PMCID: PMC6167479 DOI: 10.3389/fneur.2018.00784] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Endovascular treatment (EVT) is effective for stroke patients with a large vessel occlusion (LVO) of the anterior circulation. To further improve personalized stroke care, it is essential to accurately predict outcome after EVT. Machine learning might outperform classical prediction methods as it is capable of addressing complex interactions and non-linear relations between variables. Methods: We included patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, an observational cohort of LVO patients treated with EVT. We applied the following machine learning algorithms: Random Forests, Support Vector Machine, Neural Network, and Super Learner and compared their predictive value with classic logistic regression models using various variable selection methodologies. Outcome variables were good reperfusion (post-mTICI ≥ 2b) and functional independence (modified Rankin Scale ≤2) at 3 months using (1) only baseline variables and (2) baseline and treatment variables. Area under the ROC-curves (AUC) and difference of mean AUC between the models were assessed. Results: We included 1,383 EVT patients, with good reperfusion in 531 (38%) and functional independence in 525 (38%) patients. Machine learning and logistic regression models all performed poorly in predicting good reperfusion (range mean AUC: 0.53–0.57), and moderately in predicting 3-months functional independence (range mean AUC: 0.77–0.79) using only baseline variables. All models performed well in predicting 3-months functional independence using both baseline and treatment variables (range mean AUC: 0.88–0.91) with a negligible difference of mean AUC (0.01; 95%CI: 0.00–0.01) between best performing machine learning algorithm (Random Forests) and best performing logistic regression model (based on prior knowledge). Conclusion: In patients with LVO machine learning algorithms did not outperform logistic regression models in predicting reperfusion and 3-months functional independence after endovascular treatment. For all models at time of admission radiological outcome was more difficult to predict than clinical outcome.
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Affiliation(s)
| | - Lucas A Ramos
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, Netherlands
| | - Adam Hilbert
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs van Leeuwen
- Leiden Institute for Advanced Computer Sciences, Leiden University, Leiden, Netherlands
| | | | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Silvia D Olabarriaga
- Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, Netherlands
| | - Koos H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, Netherlands
| | - Esmee Venema
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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Peippo MH, Kurki S, Lassila R, Carpén OM. Real-world features associated with cancer-related venous thromboembolic events. ESMO Open 2018; 3:e000363. [PMID: 30094068 PMCID: PMC6069925 DOI: 10.1136/esmoopen-2018-000363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/30/2018] [Accepted: 06/02/2018] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of venous thromboembolism (VTE) is 1–2/1000 individuals. Patients with cancer, especially during chemotherapy, are at enhanced risk, but real-world data on factors associated with VTE events are still scarce. Aim The aim of this retrospective study was to survey the incidence of VTE based on a large hospital database, and to identify comorbidities and features associated with VTE events. We focused on cancer-related VTE events and on factors indicating increased VTE risk during chemotherapy. Methods The cohort included patients treated at Turku University Hospital during years 2005–2013. Health information was derived and analysed from multiple electronic databases. The diagnoses of VTE and all comorbidities, including type of cancer, were based on International Classification of Diseases 10th Revision coding. For further analysis, we focused on 16 common types of cancers treated with chemotherapy. Age, gender, surgery, radiotherapy, distant metastasis, available laboratory values and platinum-based chemotherapy were evaluated for VTE group, and associations were estimated by Cox regression analyses. Results The entire database contained information from 495 089 patients, of whom 5452 (1.1%) had a VTE diagnosis. Among individuals with VTE, 1437 (26.4%) had diagnosis of coronary heart disease and 1467 (26.9%) had cancer diagnosis. Among 7778 patients with cancer treated with chemotherapy, 282 (3.6%) had a VTE, platinum-based chemotherapy being a major risk factor (HR 1.77, 95% CI 1.40 to 2.24, p<0.001). In multivariate analysis, elevated blood neutrophil counts (>3.25×109 cells/L, HR 1.96, 95% CI 1.33 to 2.89, p<0.001) and plasma creatinine (>62.5 μmol/L; HR 1.60, 95% CI 1.21 to 2.13, p=0.001) values were independent indicators of increased VTE risk during chemotherapy. Conclusions Longitudinal electronic health record analysis provides a powerful tool to gather meaningful real-world information to study clinical associations, like comorbidities, and to identify markers associated with VTE. The combination of various clinical and laboratory variables could be used for VTE risk evaluation and targeted prevention.
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Affiliation(s)
- Maija Helena Peippo
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, University of Turku, Turku, Finland
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Riitta Lassila
- Unit of Coagulation Disorders, Department of Hematology and Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Mikael Carpén
- Genome Scale Biology Research Program and Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Kuderer NM, Poniewierski MS, Culakova E, Lyman GH, Khorana AA, Pabinger I, Agnelli G, Liebman HA, Vicaut E, Meyer G, Shepherd FA. Predictors of Venous Thromboembolism and Early Mortality in Lung Cancer: Results from a Global Prospective Study (CANTARISK). Oncologist 2017; 23:247-255. [PMID: 28951500 DOI: 10.1634/theoncologist.2017-0205] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with lung cancer are known to be at increased risk for venous thromboembolism (VTE). Venous thromboembolism is associated with increased risk for early mortality. However, there have been no studies performing a comprehensive assessment of risk factors for VTE or early mortality in lung cancer patients undergoing systemic chemotherapy in a global real-world setting. MATERIALS AND METHODS CANTARISK is a prospective, global, noninterventional cohort study including patients with lung cancer initiating a new cancer therapy. Clinical data were collected until 6-month follow-up. The impact of patient-, disease-, and treatment-related factors on the occurrence of VTE and early mortality was evaluated in univariable and multivariable Cox regression analyses. A previously validated VTE risk score (VTE-RS) was also calculated (also known as Khorana score). RESULTS Of 1,980 patients with lung cancer who were enrolled from 2011 to 2012, 84% had non-small cell lung cancer. During the first 6 months, 121 patients developed a VTE (6.1%), of which 47% had pulmonary embolism, 46% deep vein thrombosis, 3% catheter-associated thrombosis, and 4% visceral thrombosis. Independent predictors for VTE included female sex, North America location, leg immobilization, and presence of a central venous catheter. The VTE-RS was not significantly associated with VTE in either univariable or multivariable analysis in this population. During the study period, 472 patients died, representing 20%, 24%, 36%, and 25% with VTE-RS 1, 2, ≥3, or unknown, respectively (p < .0001). Significant independent predictors of early mortality include older age, current/former smoking, chronic obstructive pulmonary disease, Eastern Cooperative Oncology Group performance status ≥2, no prior surgery, and metastatic disease, as well as the VTE-RS. CONCLUSION In this global, prospective, real-world analysis, several demographic, geographic, and clinical factors are independent risk factors for VTE and early mortality in patients with lung cancer. The VTE-RS represents a significant independent predictor of early mortality but not for VTE in lung cancer in the era of targeted therapy. IMPLICATIONS FOR PRACTICE Multiple risk factors for both venous thromboembolism (VTE) and early mortality in patients with lung cancer receiving systemic chemotherapy should guide best practice by better informing clinical evaluation and treatment decision-making. The Khorana risk score is of value in assessing the risk of early all-cause mortality along with other clinical parameters in patients with lung cancer receiving systemic therapy. Further study is needed to fully evaluate the validity of the risk score in predicting the risk of VTE in the modern era of lung cancer therapy.
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Affiliation(s)
- Nicole M Kuderer
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marek S Poniewierski
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Eva Culakova
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alok A Khorana
- Department of Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ingrid Pabinger
- Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Agnelli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Howard A Liebman
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eric Vicaut
- Department of Medicine, Université Paris Descartes, Paris, France
| | - Guy Meyer
- Department of Medicine, Université Paris Descartes, Paris, France
| | - Frances A Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Validation of a Machine Learning Approach for Venous Thromboembolism Risk Prediction in Oncology. DISEASE MARKERS 2017; 2017:8781379. [PMID: 29104344 PMCID: PMC5623790 DOI: 10.1155/2017/8781379] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/30/2017] [Indexed: 02/08/2023]
Abstract
Using kernel machine learning (ML) and random optimization (RO) techniques, we recently developed a set of venous thromboembolism (VTE) risk predictors, which could be useful to devise a web interface for VTE risk stratification in chemotherapy-treated cancer patients. This study was designed to validate a model incorporating the two best predictors and to compare their combined performance with that of the currently recommended Khorana score (KS). Age, sex, tumor site/stage, hematological attributes, blood lipids, glycemic indexes, liver and kidney function, BMI, performance status, and supportive and anticancer drugs of 608 cancer outpatients were all entered in the model, with numerical attributes analyzed as continuous values. VTE rate was 7.1%. The VTE risk prediction performance of the combined model resulted in 2.30 positive likelihood ratio (+LR), 0.46 negative LR (−LR), and 4.88 HR (95% CI: 2.54–9.37), with a significant improvement over the KS [HR 1.73 (95% CI: 0.47–6.37)]. These results confirm that a ML approach might be of clinical value for VTE risk stratification in chemotherapy-treated cancer outpatients and suggest that the ML-RO model proposed could be useful to design a web service able to provide physicians with a graphical interface helping in the critical phase of decision making.
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Guadagni F, Riondino S, Formica V, Del Monte G, Morelli AM, Lucchetti J, Spila A, D’Alessandro R, Della-Morte D, Ferroni P, Roselli M. Clinical significance of glycemic parameters on venous thromboembolism risk prediction in gastrointestinal cancer. World J Gastroenterol 2017; 23:5187-5195. [PMID: 28811713 PMCID: PMC5537185 DOI: 10.3748/wjg.v23.i28.5187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/04/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the possible predictive role of routinely used glycemic parameters for a first venous thromboembolism (VTE) episode in gastrointestinal (GI) cancer ambulatory patients - with or without clinically diagnosed type 2 diabetes (T2D) or obesity - treated with chemotherapy.
METHODS Pre-treatment fasting blood glucose, insulin, glycated hemoglobin (HbA1c) and homeostasis model of risk assessment (HOMA) were retrospectively evaluated in a cohort study of 342 GI cancer patients. Surgery was performed in 142 (42%) patients with primary cancer, 30 (21%) and 112 (79%) of whom received neoadjuvant and adjuvant therapies, respectively. First-line chemotherapy was administered in 200 (58%) patients with metastatic disease. The study outcome was defined as the occurrence of a first symptomatic or asymptomatic VTE episode during active treatment.
RESULTS Impaired glucose tolerance (IGT) or T2D were diagnosed in 30% of GI cancer patients, while overweight/obesity had an incidence of 41%. VTE occurred in 9.4% of patients (7% of non-diabetic non-obese), especially in those with a high ECOG score (P = 0.025). No significant association was found between VTE incidence and T2D, obesity, different tumor types, metastatic disease, Khorana class of risk, or different anti-cancer drugs, although VTE rates were substantially higher in patients receiving bevacizumab (17% vs 8%, P = 0.044). Conversely, all glucose metabolic indexes were associated with increased VTE risk at ROC analysis. Multivariate Cox proportional analyses confirmed that HOMA index (HR = 4.13, 95%CI: 1.63-10.5) or fasting blood glucose (HR = 3.56, 95%CI: 1.51-8.39) were independent predictors of VTE occurrence during chemotherapy.
CONCLUSION The results here reported demonstrate that evaluating glucose metabolic asset may allow for VTE risk stratification in GI cancer, helping to identify chemotherapy-treated patients who might benefit from thromboprophylaxis. Further multicenter prospective studies involving a larger number of patients are presently needed.
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