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      Prediction model of acute kidney injury after different types of acute aortic dissection based on machine learning

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          Abstract

          Objective

          A clinical prediction model for postoperative combined Acute kidney injury (AKI) in patients with Type A acute aortic dissection (TAAAD) and Type B acute aortic dissection (TBAAD) was constructed by using Machine Learning (ML).

          Methods

          Baseline data was collected from Acute aortic division (AAD) patients admitted to First Affiliated Hospital of Xinjiang Medical University between January 1, 2019 and December 31, 2021. (1) We identified baseline Serum creatinine (SCR) estimation methods and used them as a basis for diagnosis of AKI. (2) Divide their total datasets randomly into Training set (70%) and Test set (30%), Bootstrap modeling and validation of features using multiple ML methods in the training set, and select models corresponding to the largest Area Under Curve (AUC) for follow-up studies. (3) Screening of the best ML model variables through the model visualization tools Shapley Addictive Explanations (SHAP) and Recursive feature reduction (REF). (4) Finally, the pre-screened prediction models were evaluated using test set data from three aspects: discrimination, Calibration, and clinical benefit.

          Results

          The final incidence of AKI was 69.4% (120/173) in 173 patients with TAAAD and 28.6% (81/283) in 283 patients with TBAAD. For TAAAD-AKI, the Random Forest (RF) model showed the best prediction performance in the training set (AUC = 0.760, 95% CI:0.630–0.881); while for TBAAD-AKI, the Light Gradient Boosting Machine (LightGBM) model worked best (AUC = 0.734, 95% CI:0.623–0.847). Screening of the characteristic variables revealed that the common predictors among the two final prediction models for postoperative AKI due to AAD were baseline SCR, Blood urea nitrogen (BUN) and Uric acid (UA) at admission, Mechanical ventilation time (MVT). The specific predictors in the TAAAD-AKI model are: White blood cell (WBC), Platelet (PLT) and D dimer at admission, Plasma The specific predictors in the TBAAD-AKI model were N-terminal pro B-type natriuretic peptide (BNP), Serum kalium, Activated partial thromboplastin time (APTT) and Systolic blood pressure (SBP) at admission, Combined renal arteriography in surgery. Finally, we used in terms of Discrimination, the ROC value of the RF model for TAAAD was 0.81 and the ROC value of the LightGBM model for TBAAD was 0.74, both with good accuracy. In terms of calibration, the calibration curve of TAAAD-AKI's RF fits the ideal curve the best and has the lowest and smallest Brier score (0.16). Similarly, the calibration curve of TBAAD-AKI's LightGBM model fits the ideal curve the best and has the smallest Brier score (0.15). In terms of Clinical benefit, the best ML models for both types of AAD have good Net benefit as shown by Decision Curve Analysis (DCA).

          Conclusion

          We successfully constructed and validated clinical prediction models for the occurrence of AKI after surgery in TAAAD and TBAAD patients using different ML algorithms. The main predictors of the two types of AAD-AKI are somewhat different, and the strategies for early prevention and control of AKI are also different and need more external data for validation.

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          Most cited references45

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

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            Machine Learning in Medicine

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              Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group

              Introduction There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. Methods We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. Results We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at ) Conclusion Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.
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                Author and article information

                Contributors
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                21 September 2022
                2022
                : 9
                : 984772
                Affiliations
                [1] 1Kidney Disease Center of the First Affiliated Hospital of Xinjiang Medical University , Urumqi, China
                [2] 2Xinjiang Branch of National Clinical Research Center for Kidney Disease, Institute of Nephrology of Xinjiang , Urumqi, China
                [3] 3Xinjiang Blood Purification Medical Quality Control Center , Urumqi, China
                [4] 4School of Public Health, Xinjiang Medical University , Urumqi, China
                Author notes

                Edited by: Tobias Eckle, University of Colorado Anschutz Medical Campus, United States

                Reviewed by: Federica Piani, University of Bologna, Italy; Ying-Ying Zheng, First Affiliated Hospital of Zhengzhou University, China

                *Correspondence: Li Suhua lisuhuanh@ 123456sina.com

                This article was submitted to Cardiovascular Therapeutics, a section of the journal Frontiers in Cardiovascular Medicine

                Article
                10.3389/fcvm.2022.984772
                9535339
                36211563
                02ea9def-54ab-48a8-af66-d85fca217fcf
                Copyright © 2022 Xinsai, Zhengye, Xuan, Xueqian, Kai, Sisi, Xuyan and Suhua.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 02 July 2022
                : 30 August 2022
                Page count
                Figures: 7, Tables: 4, Equations: 0, References: 46, Pages: 16, Words: 8330
                Categories
                Cardiovascular Medicine
                Original Research

                acute renal injury,machine learning,prediction model,acute aortic dissection,type a acute aortic dissection,type b acute aortic dissection

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