期刊
FRONTIERS IN PEDIATRICS
卷 9, 期 -, 页码 -出版社
FRONTIERS MEDIA SA
DOI: 10.3389/fped.2021.756095
关键词
machine learning; Kawasaki disease; intravenous immunoglobulin resistance; risk factors; prediction model
类别
资金
- Smart Medicine Research Project of Chongqing Medical University [ZHYX2019017, YJSZHYX202015]
- Humanities and Social Science Foundation of Chongqing Medical University [201724]
- Innovation experiment project of School of medical information
- Chongqing Medical University
- [2019C010]
The study identified total bilirubin (TBIL), procalcitonin (PCT), alanine aminotransferase (ALT), and platelet count (PLT) as independent risk factors for intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD) patients. The LightGBM prediction model, based on these risk factors, showed superior performance in predicting IVIG resistance compared to previous models.
Objective: We explored the risk factors for intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD) and constructed a prediction model based on machine learning algorithms.Methods: A retrospective study including 1,398 KD patients hospitalized in 7 affiliated hospitals of Chongqing Medical University from January 2015 to August 2020 was conducted. All patients were divided into IVIG-responsive and IVIG-resistant groups, which were randomly divided into training and validation sets. The independent risk factors were determined using logistic regression analysis. Logistic regression nomograms, support vector machine (SVM), XGBoost and LightGBM prediction models were constructed and compared with the previous models.Results: In total, 1,240 out of 1,398 patients were IVIG responders, while 158 were resistant to IVIG. According to the results of logistic regression analysis of the training set, four independent risk factors were identified, including total bilirubin (TBIL) (OR = 1.115, 95% CI 1.067-1.165), procalcitonin (PCT) (OR = 1.511, 95% CI 1.270-1.798), alanine aminotransferase (ALT) (OR = 1.013, 95% CI 1.008-1.018) and platelet count (PLT) (OR = 0.998, 95% CI 0.996-1). Logistic regression nomogram, SVM, XGBoost, and LightGBM prediction models were constructed based on the above independent risk factors. The sensitivity was 0.617, 0.681, 0.638, and 0.702, the specificity was 0.712, 0.841, 0.967, and 0.903, and the area under curve (AUC) was 0.731, 0.814, 0.804, and 0.874, respectively. Among the prediction models, the LightGBM model displayed the best ability for comprehensive prediction, with an AUC of 0.874, which surpassed the previous classic models of Egami (AUC = 0.581), Kobayashi (AUC = 0.524), Sano (AUC = 0.519), Fu (AUC = 0.578), and Formosa (AUC = 0.575).Conclusion: The machine learning LightGBM prediction model for IVIG-resistant KD patients was superior to previous models. Our findings may help to accomplish early identification of the risk of IVIG resistance and improve their outcomes.
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