Performance of Machine Learning Algorithms for Predicting Adverse Outcomes in Community-Acquired Pneumonia.

Background: The ability to assess adverse outcomes in patients with community-acquired pneumonia (CAP) could improve clinical decision-making to enhance clinical practice, but the studies remain insufficient, and similarly, few machine learning (ML) models have been developed. Objective: We aimed to explore the effectiveness of predicting adverse outcomes in CAP through ML models. Methods: A total of 2,302 adults with CAP who were prospectively recruited between January 2012 and March 2015 across three cities in South America were extracted from DryadData. After a 70:30 training set: test set split of the data, nine ML algorithms were executed and their diagnostic accuracy was measured mainly by the area under the curve (AUC). The nine ML algorithms included decision trees, random forests, extreme gradient boosting (XGBoost), support vector machines, Naïve Bayes, K-nearest neighbors, ridge regression, logistic regression without regularization, and neural networks. The adverse outcomes included hospital admission, mortality, ICU admission, and one-year post-enrollment status. Results: The XGBoost algorithm had the best performance in predicting hospital admission. Its AUC reached 0.921, and accuracy, precision, recall, and F1-score were better than those of other models. In the prediction of ICU admission, a model trained with the XGBoost algorithm showed the best performance with AUC 0.801. XGBoost algorithm also did a good job at predicting one-year post-enrollment status. The results of AUC, accuracy, precision, recall, and F1-score indicated the algorithm had high accuracy and precision. In addition, the best performance was seen by the neural network algorithm when predicting death (AUC 0.831). Conclusions: ML algorithms, particularly the XGBoost algorithm, were feasible and effective in predicting adverse outcomes of CAP patients. The ML models based on available common clinical features had great potential to guide individual treatment and subsequent clinical decisions.

Anti-Autophagy Mechanism of Zhi Gan Prescription Based on Network Pharmacology in Nonalcoholic Steatohepatitis Rats.

Background and Aims: Zhi Gan prescription (ZGP) has been clinically proven to exert a favorable therapeutic effect on nonalcoholic steatohepatitis (NASH). This study purpose to reveal the underlying molecular mechanisms of ZGP action in NASH. Methods: Systematic network pharmacology was used to identify bioactive components, potential targets, and the underlying mechanism of ZGP action in NASH. High fat (HF)-induced NASH model rats were used to assess the effect of ZGP against NASH, and to verify the possible molecular mechanisms as predicted by network pharmacology. Results: A total of 138 active components and 366 potential targets were acquired in ZGP. In addition, 823 targets of NASH were also screened. In vivo experiments showed that ZGP significantly improved the symptoms in HF-induced NASH rats. qRT-PCR and western blot analyses showed that ZGP could regulate the hub genes, PTEN, IL-6 and TNF in NASH model rats. In addition, ZGP suppressed mitochondrial autophagy through mitochondrial fusion and fission via the PINK/Parkin pathway. Conclusion: ZGP exerts its effects on NASH through mitochondrial autophagy. These findings provide novel insights into the mechanisms of ZGP in NASH.