Machine learning for the prediction of severe pneumonia during posttransplant hospitalization in recipients of a deceased-donor kidney transplant

Revisiting transplant immunology through the lens of single-cell technologies

Solid organ transplantation (SOT) is the standard of care for end-stage organ disease. The most frequent complication of SOT involves allograft rejection, which may occur via T cell- and/or antibody-mediated mechanisms. Diagnosis of rejection in the clinical setting requires an invasive biopsy as there are currently no reliable biomarkers to detect rejection episodes. Likewise, it is virtually impossible to identify patients who exhibit operational tolerance and may be candidates for reduced or complete withdrawal of immunosuppression. Emerging single-cell technologies, including cytometry by time-of-flight (CyTOF), imaging mass cytometry, and single-cell RNA sequencing, represent a new opportunity for deep characterization of pathogenic immune populations involved in both allograft rejection and tolerance in clinical samples. These techniques enable examination of both individual cellular phenotypes and cell-to-cell interactions, ultimately providing new insights into the complex pathophysiology of allograft rejection. However, working with these large, highly dimensional datasets requires expertise in advanced data processing and analysis using computational biology techniques. Machine learning algorithms represent an optimal strategy to analyze and create predictive models using these complex datasets and will likely be essential for future clinical application of patient level results based on single-cell data. Herein, we review the existing literature on single-cell techniques in the context of SOT.

The Emerging Role of Implementing Machine Learning in Food Recommendation for Chronic Kidney Diseases Using Correlation Analysis

Kidneys are vital organs in the human body, and their effective functioning determines life quality. Chronic kidney illness is a kind of nephrotic syndrome in which the kidneys’ capacity to cope normally steadily deteriorates and remains asymptomatic for a long period as the disease progresses. An early CKD detection would help the patient recover faster and easier. Using an artificial intelligence system that can effectively aid in CKD detection in time and suggest the required food nutrition for its treatment and recovery would reap immense benefits for healthcare professionals as well as the patient. ML is a part of AI technology that has been used for effective medical development. This technology helps physicians in the accurate diagnosis of kidney disease and helps in effective treatment prediction by recommending required nutrition. The present research relates to the use of ML in proper kidney disease diagnosis and food recommendations for treatment accordingly. A correlation analysis has been done in this research to observe the strength of ML using the effective finding for renal malfunctioning and identifying the best food products that could help in its treatment and recovery. IBM SPSS version 26 has been used for this research. The correlation analysis has been done to observe the impact of eight independent variables that are age, gender, blood sugar, serum albumin, creatinine, potassium, bacteria, and pus secretion on the two dependent variables that are the risk of CKD occurrence and ML accuracy. The results have exposed that the autonomous values consist of a strong positive correlation with the dependent variable ( $p<0.005$ ). The statistical significance values have proved that the dependent values are statistically significant (0.001). The value of ML accuracy at a 95% confidence level has been observed at 88.85%, and the CKD occurrence value is 86.95%. The results have proved that the ML algorithm detects the risk of CKD occurrence accurately in each stage via analyzing blood sugar, creatinine, and potassium levels. The result also shows that the risk of CKD enhances with an increase in age.

Technology-Enabled Care and Artificial Intelligence in Kidney Transplantation

Purpose of Review

Artificial intelligence (AI), machine learning, and technology-enabled remote patient care have evolved rapidly and have now been incorporated into many aspects of medical care. Transplantation is fortunate to have large data sets upon which machine learning algorithms can be constructed. AI are now available to improve pretransplant management, donor selection, and post-operative management of transplant patients.

Recent Findings

Changes in patient and donor characteristics warrant new approaches to listing and organ acceptance practices. Machine learning has been employed to optimize donor selection to identify patients likely to benefit from transplantation of higher risk organs, increasing organ discard and reducing waitlist mortality. These models have greater precisions and predictive ability than currently employed metrics including the Kidney Donor Profile Index and the expected posttransplant survival models. After transplant, AI tools have been developed to optimize immunosuppression management, track patients adherence, and assess graft survival.

Summary

AI and technology-enabled management tools are now available throughout the transplant journey. Unfortunately, those are frequently not available at the point of decision (patient listing, organ acceptance, posttransplant clinic), limiting utilization. Incorporation of these tools into the EMR, the Donor Net® organ offer system, and mobile devices is vital to ensure widespread adoption.

Artificial intelligence and kidney transplantation

Artificial intelligence and its primary subfield, machine learning, have started to gain widespread use in medicine, including the field of kidney transplantation. We made a review of the literature that used artificial intelligence techniques in kidney transplantation. We located six main areas of kidney transplantation that artificial intelligence studies are focused on: Radiological evaluation of the allograft, pathological evaluation including molecular evaluation of the tissue, prediction of graft survival, optimizing the dose of immunosuppression, diagnosis of rejection, and prediction of early graft function. Machine learning techniques provide increased automation leading to faster evaluation and standardization, and show better performance compared to traditional statistical analysis. Artificial intelligence leads to improved computer-aided diagnostics and quantifiable personalized predictions that will improve personalized patient care.

Supervised machine learning-based prediction for in-hospital pressure injury development using electronic health records: A retrospective observational cohort study in a university hospital in Japan

BACKGROUND

In hospitals, nurses are responsible for pressure injury risk assessment using several kinds of risk assessment scales. However, their predictive validity is insufficient to initiate targeted preventive strategy for each patient. The use of electronic health records with machine learning technique is a promising strategy to provide automated clinical decision-making aid.

OBJECTIVE

The purpose of this study was to construct a predictive model for pressure injury development which included feature variables that can be collected on the first day of hospitalization by nurses who routinely input the data to electronic health records.

DESIGN

Retrospective observational cohort study.

SETTING

This study was conducted at a university hospital in Japan.

PARTICIPANTS

This study used electronic health records, which include entry/discharge records, basic nursing records, and pressure injury management documents (N = 75,353).

METHODS

The outcome measure was the pressure injuries which developed outside of an operation theatre and frequently appeared on the specific body parts at high risk of pressure injury development. We utilized four major classifiers: logistic regression, random forest, linear support vector machine, and extreme gradient boosting (XGBoost) with 5-fold cross-validation technique. The area under the receiver operating characteristic curve (AUC) was used for evaluating predictive performance.

RESULTS

The proportion of hospital-acquired pressure injuries was 0.52%. The receiver operating characteristic curves revealed the best predictive performance for the XGBoost model, achieving the highest sensitivity of 0.78±0.03 and AUC of 0.80±0.02 amongst four types of classifiers. Variables related to difficulty in activities of daily living, anorexia, and respiratory or cardiac disorders were extracted as important features.

CONCLUSIONS

Our findings suggest that routinely collected health data by nurses on the first day of patient admission have the potential to help determine high-risk patients for pressure injury development. Tweetable abstract: Machine learning models on routinely collected electronic health records data successfully predict pressure injury development during hospitalization.

FUNDING

This work was supported by a JSPS KAKENHI Grant-in-Aid for Exploratory Research (16K15865).

How will artificial intelligence and bioinformatics change our understanding of IgA Nephropathy in the next decade?

IgA nephropathy (IgAN) is the most common glomerulonephritis. It is characterized by the deposition of immune complexes containing immunoglobulin A (IgA) in the kidney’s glomeruli, triggering an inflammatory process. In many patients, the disease has a progressive course, eventually leading to end-stage kidney disease. The current understanding of IgAN’s pathophysiology is incomplete, with the involvement of several potential players, including the mucosal immune system, the complement system, and the microbiome. Dissecting this complex pathophysiology requires an integrated analysis across molecular, cellular, and organ scales. Such data can be obtained by employing emerging technologies, including single-cell sequencing, next-generation sequencing, proteomics, and complex imaging approaches. These techniques generate complex “big data,” requiring advanced computational methods for their analyses and interpretation. Here, we introduce such methods, focusing on the broad areas of bioinformatics and artificial intelligence and discuss how they can advance our understanding of IgAN and ultimately improve patient care. The close integration of advanced experimental and computational technologies with medical and clinical expertise is essential to improve our understanding of human diseases. We argue that IgAN is a paradigmatic disease to demonstrate the value of such a multidisciplinary approach.

Toward Advancing Long-Term Outcomes of Kidney Transplantation with Artificial Intelligence

After decades of pioneering advances and improvements, kidney transplantation is now the renal replacement therapy of choice for most patients with end-stage kidney disease (ESKD). Despite this success, the high risk of premature death and frequent occurrence of graft failure remain important clinical and research challenges. The current burst of studies and other innovative initiatives using artificial intelligence (AI) for a wide range of analytical and practical applications in biomedical areas seems to correlate with the same trend observed in publications in the kidney transplantation field, and points toward the potential of such novel approaches to address the aforementioned aim of improving long-term outcomes of kidney transplant recipients (KTR). However, at the same time, this trend underscores now more than ever the old methodological challenges and potential threats that the research and clinical community needs to be aware of and actively look after with regard to AI-driven evidence. The purpose of this narrative mini-review is to explore challenges for obtaining applicable and adequate kidney transplant data for analyses using AI techniques to develop prediction models, and to propose next steps in the field. We make a call to act toward establishing the strong collaborations needed to bring innovative synergies further augmented by AI, which have the potential to impact the long-term care of KTR. We encourage researchers and clinicians to submit their invaluable research, including original clinical and imaging studies, database studies from registries, meta-analyses, and AI research in the kidney transplantation field.

Development and performance assessment of novel machine learning models to predict pneumonia after liver transplantation

Background

Pneumonia is the most frequently encountered postoperative pulmonary complications (PPC) after orthotopic liver transplantation (OLT), which cause high morbidity and mortality rates. We aimed to develop a model to predict postoperative pneumonia in OLT patients using machine learning (ML) methods.

Methods

Data of 786 adult patients underwent OLT at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to September 2019 was retrospectively extracted from electronic medical records and randomly subdivided into a training set and a testing set. With the training set, six ML models including logistic regression (LR), support vector machine (SVM), random forest (RF), adaptive boosting (AdaBoost), extreme gradient boosting (XGBoost) and gradient boosting machine (GBM) were developed. These models were assessed by the area under curve (AUC) of receiver operating characteristic on the testing set. The related risk factors and outcomes of pneumonia were also probed based on the chosen model.

Results

591 OLT patients were eventually included and 253 (42.81%) were diagnosed with postoperative pneumonia, which was associated with increased postoperative hospitalization and mortality (P < 0.05). Among the six ML models, XGBoost model performed best. The AUC of XGBoost model on the testing set was 0.734 (sensitivity: 52.6%; specificity: 77.5%). Pneumonia was notably associated with 14 items features: INR, HCT, PLT, ALB, ALT, FIB, WBC, PT, serum Na⁺, TBIL, anesthesia time, preoperative length of stay, total fluid transfusion and operation time.

Conclusion

Our study firstly demonstrated that the XGBoost model with 14 common variables might predict postoperative pneumonia in OLT patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-021-01690-3.

Predicting the postoperative blood coagulation state of children with congenital heart disease by machine learning based on real-world data

BACKGROUND

Postoperative blood coagulation assessment of children with congenital heart disease (CHD) has been developed using a conventional statistical approach. In this study, the machine learning (ML) was used to predict postoperative blood coagulation function of children with CHD, and assess an array of ML models.

METHODS

This was a retrospective and data mining study. Based on the samples of 1,690 children with CHD, and screening data based on demographic characteristics, conventional coagulation tests (CCTs) and complete blood count (CBC), with a precise data selection process, and the support of data mining and ML algorithms including Decision tree, Naive Bayes, Support Vector Machine (SVM), Adaptive Boost (AdaBoost) and Random Forest model, and explored the best prediction models of postoperative blood coagulation function for children with CHD by models performance measured in the area under the receiver operating characteristic (ROC) curve (AUC), calibration or Lift curves, and further verified the reliability of the models with statistical tests.

RESULTS

In primary objective prediction, as decision tree, Naive Bayes, SVM, the AUC of our prediction algorithm was 0.81, 0.82, 0.82, respectively. The accuracy rate of the overall forecast has reached more than 75%. Subsequently, we furtherly build improved models. Among them, the true positive rate of the AdaBoost, Random Forest and SVM prediction models reached more than 80% in the ROC curve. These overall accuracy rate indicated a good classification model. Combined calibration curves and Lift curves, the better fit is the SVM model, which predicted postoperative abnormal coagulation, Lift =2.2, postoperative normal coagulation, Lift =1.8. The statistical results furtherly proved the reliability of ML models. The age, sex, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), white blood cell count (WBC) and platelet count (PLT) were the key features for predicting the postoperative blood coagulation state of children with CHD.

CONCLUSIONS

ML technology and data mining algorithms may be used for outcome prediction in children with CHD for postoperative blood coagulation state based on the bulk of clinical data, especially CBC indictors from the real world.

Neutrophil-to-Lymphocyte Ratio Predicts Mortality in Adult Renal Transplant Recipients with Severe Community-Acquired Pneumonia

Mortality of renal transplant recipients with severe community-acquired pneumonia (CAP) remains high, despite advances in critical care management. There is still a lack of biomarkers for predicting prognosis of these patients. The present study aimed to investigate the association between neutrophil-to-lymphocyte ratio (NLR) and mortality in renal transplant recipients with severe CAP. A total of 111 renal transplant recipients with severe CAP admitted to the intensive care unit (ICU) were screened for eligibility between 1 January 2009 and 30 November 2018. Patient characteristics and laboratory test results at ICU admission were retrospectively collected. There were 18 non-survivors (22.2%) among 81 patients with severe CAP who were finally included. Non-survivors had a higher NLR level than survivors (26.8 vs. 12.3, p < 0.001). NLR had the greatest power to predict mortality as suggested by area under the curve (0.88 ± 0.04; p < 0.0001) compared to platelet-to-lymphocyte ratio (0.75 ± 0.06; p < 0.01), pneumonia severity index (0.65 ± 0.08; p = 0.05), CURB-65 (0.65 ± 0.08; p = 0.05), and neutrophil count (0.68 ± 0.07; p < 0.01). Multivariate logistic regression models revealed that NLR was associated with hospital and ICU mortality in renal transplant recipients with severe CAP. NLR levels were independently associated with mortality and may be a useful biomarker for predicting poor outcome in renal transplant recipients with severe CAP.

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

Kidney diseases form part of the major health burdens experienced all over the world. Kidney diseases are linked to high economic burden, deaths, and morbidity rates. The great importance of collecting a large quantity of health-related data among human cohorts, what scholars refer to as “big data”, has increasingly been identified, with the establishment of a large group of cohorts and the usage of electronic health records (EHRs) in nephrology and transplantation. These data are valuable, and can potentially be utilized by researchers to advance knowledge in the field. Furthermore, progress in big data is stimulating the flourishing of artificial intelligence (AI), which is an excellent tool for handling, and subsequently processing, a great amount of data and may be applied to highlight more information on the effectiveness of medicine in kidney-related complications for the purpose of more precise phenotype and outcome prediction. In this article, we discuss the advances and challenges in big data, the use of EHRs and AI, with great emphasis on the usage of nephrology and transplantation.