Computational platform for doctor-artificial intelligence cooperation in pulmonary arterial hypertension prognostication: a pilot study.

Autor:	Kheyfets VO; Paediatric Critical Care Medicine, Developmental Lung Biology and CVP Research Laboratories, School of Medicine, University of Colorado, Aurora, CO, USA., Sweatt AJ; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, USA., Gomberg-Maitland M; Division of Cardiology, George Washington University Hospital, Washington, DC, USA., Ivy DD; Department of Paediatric Cardiology, Children's Hospital Colorado, Aurora, CO, USA., Condliffe R; Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK., Kiely DG; Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.; Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK., Lawrie A; Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.; Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK., Maron BA; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, MA, USA., Zamanian RT; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, USA., Stenmark KR; Paediatric Critical Care Medicine, Developmental Lung Biology and CVP Research Laboratories, School of Medicine, University of Colorado, Aurora, CO, USA.
Jazyk:	angličtina
Zdroj:	ERJ open research [ERJ Open Res] 2023 Feb 06; Vol. 9 (1). Date of Electronic Publication: 2023 Feb 06 (Print Publication: 2023).
DOI:	10.1183/23120541.00484-2022
Abstrakt:	Background: Pulmonary arterial hypertension (PAH) is a heterogeneous and complex pulmonary vascular disease associated with substantial morbidity. Machine-learning algorithms (used in many PAH risk calculators) can combine established parameters with thousands of circulating biomarkers to optimise PAH prognostication, but these approaches do not offer the clinician insight into what parameters drove the prognosis. The approach proposed in this study diverges from other contemporary phenotyping methods by identifying patient-specific parameters driving clinical risk. Methods: We trained a random forest algorithm to predict 4-year survival risk in a cohort of 167 adult PAH patients evaluated at Stanford University, with 20% withheld for (internal) validation. Another cohort of 38 patients from Sheffield University were used as a secondary (external) validation. Shapley values, borrowed from game theory, were computed to rank the input parameters based on their importance to the predicted risk score for the entire trained random forest model (global importance) and for an individual patient (local importance). Results: Between the internal and external validation cohorts, the random forest model predicted 4-year risk of death/transplant with sensitivity and specificity of 71.0-100% and 81.0-89.0%, respectively. The model reinforced the importance of established prognostic markers, but also identified novel inflammatory biomarkers that predict risk in some PAH patients. Conclusion: These results stress the need for advancing individualised phenotyping strategies that integrate clinical and biochemical data with outcome. The computational platform presented in this study offers a critical step towards personalised medicine in which a clinician can interpret an algorithm's assessment of an individual patient. Competing Interests: Conflict of interest: None declared. (Copyright ©The authors 2023.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu