Estimating the rupture risk of small intracranial aneurysms (IAs) to determine whether to treat is di cult but crucial. We aimed to construct and external validation a convenient machine learning (ML) model for assessing the rupture risk of small IAs.1004 patients with small IAs recruited from two hospitals were included in our retrospective research. The patients at hospital 1 were strati ed into training (70%) and internal validation set (30%) randomly, and the patients at hospital 2 were used for external validation. We selected predictive features using the least absolute shrinkage and selection operator (LASSO) method, and constructed ve ML models applying diverse algorithms including random forest classi er (RFC), categorical boosting (CatBoost), support vector machine (SVM) with linear kernel, light gradient boosting machine (LightGBM) and extreme gradient boosting (XGBoost). The Shapley Additive Explanations (SHAP) analysis provided interpretation for the best ML model.The training, internal and external validation cohorts included 658, 282, and 64 IAs, respectively. The best performance was presented by SVM as AUC of 0.817 in the internal [95% con dence interval (CI), 0.769-0.866] and 0.893 in the external (95% CI, 0.808-0.979) validation cohorts, overperformed than the PHASES score signi cantly (all P < 0.001). SHAP analysis showed maximum size, location and irregular shape were the top three important features to predict rupture. Our SVM model based on readily accessible features presented satisfying ability of discrimination in predicting the rupture IAs with small size. Morphological parameters made important contributions to prediction result.
Background The hypoxemia risk in adult (18–64) patients treated with esophagogastroduodenoscopy (EGD) under sedation often poses a dilemma for anesthesiologists. We aimed to establish an artificial neural network (ANN) model to solve this problem, and introduce the Shapley additive explanations (SHAP) algorithm to further improve the interpretability. Methods The relevant data of patients underwent routine anesthesia-assisted EGD were collected. Elastic network was used to filter the optimal features. Airway-ANN and Basic-ANN models were established based on all collected indicators and remaining variables excluding airway assessment indicators, respectively. The performance of Basic-ANN, Airway-ANN and STOP-BANG was evaluated by the area under the precision-recall curve (AUPRC) on temporal validation set. The SHAP was used for revealing the predictive behavior of our best model. Results 999 patients were eventually included. The AUPRC value of Airway-ANN model was significantly higher than Basic-ANN model in the temporal validation set (0.532 vs 0.429, P < 0.05). And the performance of both two ANN models was significantly better than that of STOP-BANG score (both P < 0.05). The Airway-ANN model was deployed to the cloud ( http://njfh-yxb.com.cn:2022/airway_ann ). Conclusion Our online interpretable Airway-ANN model achieved satisfying ability in identifying the hypoxemia risk in adult (18–64) patients undergoing EGD.
Background and PurposeAbout 20.1% of intracranial aneurysms (IAs) carriers are multiple intracranial aneurysms (MIAs) patients with higher rupture risk and worse prognosis. A prediction model may bring some potential benefits. This study attempted to develop and externally validate a dynamic nomogram to assess the rupture risk of each IA among patients with MIA.MethodWe retrospectively analyzed the data of 262 patients with 611 IAs admitted to the Hunan Provincial People's Hospital between November 2015 and November 2021. Multivariable logistic regression (MLR) was applied to select the risk factors and derive a nomogram model for the assessment of IA rupture risk in MIA patients. To externally validate the nomogram, data of 35 patients with 78 IAs were collected from another independent center between December 2009 and May 2021. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultSize, location, irregular shape, diabetes history, and neck width were independently associated with IA rupture. The nomogram showed a good discriminative ability for ruptured and unruptured IAs in the derivation cohort (AUC = 0.81; 95% CI, 0.774–0.847) and was successfully generalized in the external validation cohort (AUC = 0.744; 95% CI, 0.627–0.862). The nomogram was calibrated well, and the decision curve analysis showed that it would generate more net benefit in identifying IA rupture than the “treat all” or “treat none” strategies at the threshold probabilities ranging from 10 to 60% both in the derivation and external validation set. The web-based dynamic nomogram calculator was accessible on https://wfs666.shinyapps.io/onlinecalculator/.ConclusionExternal validation has shown that the model was the potential to assist clinical identification of dangerous aneurysms after longitudinal data evaluation. Size, neck width, and location are the primary risk factors for ruptured IAs.
Estimating the rupture risk of small intracranial aneurysms (IAs) to determine whether to treat is difficult but crucial. We aimed to construct and external validation a convenient machine learning (ML) model for assessing the rupture risk of small IAs.1004 patients with small IAs recruited from two hospitals were included in our retrospective research. The patients at hospital 1 were stratified into training (70%) and internal validation set (30%) randomly, and the patients at hospital 2 were used for external validation. We selected predictive features using the least absolute shrinkage and selection operator (LASSO) method, and constructed five ML models applying diverse algorithms including random forest classifier (RFC), categorical boosting (CatBoost), support vector machine (SVM) with linear kernel, light gradient boosting machine (LightGBM) and extreme gradient boosting (XGBoost). The Shapley Additive Explanations (SHAP) analysis provided interpretation for the best ML model.The training, internal and external validation cohorts included 658, 282, and 64 IAs, respectively. The best performance was presented by SVM as AUC of 0.817 in the internal [95% confidence interval (CI), 0.769-0.866] and 0.893 in the external (95% CI, 0.808-0.979) validation cohorts, overperformed than the PHASES score significantly (all P < 0.001). SHAP analysis showed maximum size, location and irregular shape were the top three important features to predict rupture. Our SVM model based on readily accessible features presented satisfying ability of discrimination in predicting the rupture IAs with small size. Morphological parameters made important contributions to prediction result.
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