Machine learning algorithms using national registry data to predict loss to follow- up during tuberculosis treatment.

Autor:	Rodrigues MMS; Fundação Oswaldo Cruz., Barreto-Duarte B; Universidade Salvador., Vinhaes CL; Escola Bahiana de Medicina e Saúde Pública., Araújo-Pereira M; Centro Universitário Faculdade de Tecnologia e Ciências., Fukutani ER; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz., Bergamaschi KB; Fundação Oswaldo Cruz., Kristki A; Universidade Federal do Rio de Janeiro., Cordeiro-Santos M; Fundação Medicina Tropical Doutor Heitor Vieira Dourado., Rolla VC; Instituto Nacional de Infectologia Evandro Chagas., Sterling TR; Vanderbilt University School of Medicine., Queiroz ATL; Fundação Oswaldo Cruz., Andrade BB; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz.
Jazyk:	angličtina
Zdroj:	Research square [Res Sq] 2023 Dec 11. Date of Electronic Publication: 2023 Dec 11.
DOI:	10.21203/rs.3.rs-3706875/v1
Abstrakt:	Background: Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN). Methods: We performed a retrospective study of all TB cases reported to SINAN between 2015-2022; excluding children (<18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we split our data into train (~80% data) and test (~20%), and then we compare model metrics using a test data set. Results: Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated and cured. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring system exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity, and sensibility. A user-friendly web calculator app was created (https://tbprediction.herokuapp.com/) to facilitate implementation. Conclusions: Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement. This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence. Competing Interests: Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All other authors declare no competing interests. Potential conflicts of interest: All authors: No reported conflicts of interest.
Databáze:	MEDLINE
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