Predicting Current Glycated Hemoglobin Levels in Adults From Electronic Health Records: Validation of Multiple Logistic Regression Algorithm

Improving Current Glycated Hemoglobin Prediction in Adults: Use of Machine Learning Algorithms With Electronic Health Records

Background

Predicting the risk of glycated hemoglobin (HbA_1c) elevation can help identify patients with the potential for developing serious chronic health problems, such as diabetes. Early preventive interventions based upon advanced predictive models using electronic health records data for identifying such patients can ultimately help provide better health outcomes.

Objective

Our study investigated the performance of predictive models to forecast HbA_1c elevation levels by employing several machine learning models. We also examined the use of patient electronic health record longitudinal data in the performance of the predictive models. Explainable methods were employed to interpret the decisions made by the black box models.

Methods

This study employed multiple logistic regression, random forest, support vector machine, and logistic regression models, as well as a deep learning model (multilayer perceptron) to classify patients with normal (<5.7%) and elevated (≥5.7%) levels of HbA_1c. We also integrated current visit data with historical (longitudinal) data from previous visits. Explainable machine learning methods were used to interrogate the models and provide an understanding of the reasons behind the decisions made by the models. All models were trained and tested using a large data set from Saudi Arabia with 18,844 unique patient records.

Results

The machine learning models achieved promising results for predicting current HbA_1c elevation risk. When coupled with longitudinal data, the machine learning models outperformed the multiple logistic regression model used in the comparative study. The multilayer perceptron model achieved an accuracy of 83.22% for the area under receiver operating characteristic curve when used with historical data. All models showed a close level of agreement on the contribution of random blood sugar and age variables with and without longitudinal data.

Conclusions

This study shows that machine learning models can provide promising results for the task of predicting current HbA_1c levels (≥5.7% or less). Using patients’ longitudinal data improved the performance and affected the relative importance for the predictors used. The models showed results that are consistent with comparable studies.

Inference for the Case Probability in High-dimensional Logistic Regression

Labeling patients in electronic health records with respect to their statuses of having a disease or condition, i.e. case or control statuses, has increasingly relied on prediction models using high-dimensional variables derived from structured and unstructured electronic health record data. A major hurdle currently is a lack of valid statistical inference methods for the case probability. In this paper, considering high-dimensional sparse logistic regression models for prediction, we propose a novel bias-corrected estimator for the case probability through the development of linearization and variance enhancement techniques. We establish asymptotic normality of the proposed estimator for any loading vector in high dimensions. We construct a confidence interval for the case probability and propose a hypothesis testing procedure for patient case-control labelling. We demonstrate the proposed method via extensive simulation studies and application to real-world electronic health record data.