Identifying Bladder Phenotypes After Spinal Cord Injury With Unsupervised Machine Learning: A New Way to Examine Urinary Symptoms and Quality of Life

Abstract

Purpose:Patients with spinal cord injuries (SCIs) experience variable urinary symptoms and quality of life (QOL). Our objective was to use machine learning to identify bladder-relevant phenotypes after SCI and assess their association with urinary symptoms and QOL.Materials and Methods:We used data from the Neurogenic Bladder Research Group SCI registry. Baseline variables that were previously shown to be associated with bladder symptoms/QOL were included in the machine learning environment. An unsupervised consensus clustering approach (k-prototypes) was used to identify 4 patient clusters. After qualitative review of the clusters, 2 outcomes of interest were assessed: the total Neurogenic Bladder Symptom Score (NBSS) and the NBSS-satisfaction question (QOL). The NBSS and NBSS-satisfaction question at baseline and after 1 year were compared between clusters using analysis of variance and linear regression.Results:Among the 1263 included participants, the 4 identified clusters were termed “female predominant,” “high function, low SCI complication,” “quadriplegia with bowel/bladder morbidity,” and “older, high SCI complication.” Using outcome data from baseline, significant differences were observed in the NBSS score, with the female predominant group exhibiting worse bladder symptoms. After 1 year, the overall bladder symptoms (NBSS Total) did not change significantly by cluster; however, the QOL score for the high function, low SCI complication group had more improvement (β = −0.12, P = .005), while the female predominant group had more deterioration (β = 0.09, P = .047).Conclusions:This study demonstrates the utility of machine learning in uncovering bladder-relevant phenotypes among SCI patients. Future research should explore cluster-based targeted strategies to enhance bladder-related outcomes and QOL in SCI.

Editorial Comment

“…This study applied machine-learning techniques to identify bladder-relevant phenotypes after spinal cord injuries (SCIs) and assess their association with urinary symptoms and quality of life (QOL) based on the Neurogenic Bladder Research Group SCI registry. 1 An unsupervised consensus clustering approach (k-prototypes) was used to identify 4 patient clusters. The neurogenic bladder symptom score (NBSS) and NBSS-satisfaction question at baseline and after 1 year were compared between clusters using ANOVA and linear regression.…”