Retrospective cohort study of pulmonary arterial hypertension associated with connective tissue disease effect on patients’ prognosis

Huang, Jing; An, Qi; Shi, Hongyang; Li, Cong; Zhang, Wei; Wang, Lei

doi:10.1007/s10067-023-06667-9

Cited by 1 publication

(1 citation statement)

References 56 publications

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“…Previous evidence showed that NT-proBNP was positively correlated with the severity of CAP and remained an independent mortality predictor (hazard ratio [HR]: 1.004, 95% confidence interval [95%CI]: 1.00-1.01) in multivariable analysis [40,41]. Meanwhile, in patients with CTD, elevated NT-proBNP is considered to be associated with pulmonary arterial hypertension or even heart involvement which may lead to a significant poor prognosis [42][43][44]. Although treatment with glucocorticoids or immunosuppressive drugs were not recorded, we collected and analyzed the count of lymphocyte subsets instead.…”

Section: Discussionmentioning

confidence: 99%

An explainable machine learning-based model to predict intensive care unit admission among patients with community-acquired pneumonia and connective tissue disease

Huang,

Gong,

Wei

et al. 2024

Respir Res

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Background There is no individualized prediction model for intensive care unit (ICU) admission on patients with community-acquired pneumonia (CAP) and connective tissue disease (CTD) so far. In this study, we aimed to establish a machine learning-based model for predicting the need for ICU admission among those patients. Methods This was a retrospective study on patients admitted into a University Hospital in China between November 2008 and November 2021. Patients were included if they were diagnosed with CAP and CTD during admission and hospitalization. Data related to demographics, CTD types, comorbidities, vital signs and laboratory results during the first 24 h of hospitalization were collected. The baseline variables were screened to identify potential predictors via three methods, including univariate analysis, least absolute shrinkage and selection operator (Lasso) regression and Boruta algorithm. Nine supervised machine learning algorithms were used to build prediction models. We evaluated the performances of differentiation, calibration, and clinical utility of all models to determine the optimal model. The Shapley Additive Explanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) techniques were performed to interpret the optimal model. Results The included patients were randomly divided into the training set (1070 patients) and the testing set (459 patients) at a ratio of 70:30. The intersection results of three feature selection approaches yielded 16 predictors. The eXtreme gradient boosting (XGBoost) model achieved the highest area under the receiver operating characteristic curve (AUC) (0.941) and accuracy (0.913) among various models. The calibration curve and decision curve analysis (DCA) both suggested that the XGBoost model outperformed other models. The SHAP summary plots illustrated the top 6 features with the greatest importance, including higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), lower level of CD4 + T cell, lymphocyte and serum sodium, and positive serum (1,3)-β-D-glucan test (G test). Conclusion We successfully developed, evaluated and explained a machine learning-based model for predicting ICU admission in patients with CAP and CTD. The XGBoost model could be clinical referenced after external validation and improvement.

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