Predictors of Carbohydrate Metabolism Disorders and Lethal Outcome in Patients after Myocardial Infarction: A Place of Glucose Level.

BACKGROUND AND AIM: The aim of this study was to reveal statistical patterns in patients with acute myocardial infarction (AMI) that cause the development of carbohydrate metabolism disorders (CMD) (type 2 diabetes mellitus and prediabetes) and death within 5 years after AMI. METHODS: 1079 patients who were treated with AMI in the Almazov National Medical Research Center were retrospectively selected for the study. For each patient, all data from electronic medical records were downloaded. Statistical patterns that determine the development of CMDs and death within 5 years after AMI were identified. To create and train the models used in this study, the classic methods of Data Mining, Data Exploratory Analysis, and Machine Learning were used. RESULTS: The main predictors of mortality within 5 years after AMI were advanced age, low relative level of lymphocytes, circumflex artery lesion, and glucose level. Main predictors of CMDs were low basophils, high neutrophils, high platelet distribution width, and high blood glucose level. High values of age and glucose together were relatively independent predictors. With glucose level >11 mmol/L and age >70 years, the 5-year risk of death is about 40% and it rises with increasing glucose levels. CONCLUSION: The obtained results make it possible to predict the development of CMDs and death based on simple parameters that are easily available in clinical practice. Glucose level measured on the 1st day of AMI was among the most important predictors of CMDs and death.

Hybrid Bayesian Network-Based Modeling: COVID-19-Pneumonia Case.

The primary goal of this paper is to develop an approach for predicting important clinical indicators, which can be used to improve treatment. Using mathematical predictive modeling algorithms, we examined the course of COVID-19-based pneumonia (CP) with inpatient treatment. Algorithms used include dynamic and ordinary Bayesian networks (OBN and DBN), popular ML algorithms, the state-of-the-art auto ML approach and our new hybrid method based on DBN and auto ML approaches. Predictive targets include treatment outcomes, length of stay, dynamics of disease severity indicators, and facts of prescribed drugs for different time intervals of observation. Models are validated using expert knowledge, current clinical recommendations, preceding research and classic predictive metrics. The characteristics of the best models are as follows: MAE of 3.6 days of predicting LOS (DBN plus FEDOT auto ML framework), 0.87 accuracy of predicting treatment outcome (OBN); 0.98 F1 score for predicting facts of prescribed drug (DBN). Moreover, the advantage of the proposed approach is Bayesian network-based interpretability, which is very important in the medical field. After the validation of other CP datasets for other hospitals, the proposed models can be used as part of the decision support systems for improving COVID-19-based pneumonia treatment. Another important finding is the significant differences between COVID-19 and non-COVID-19 pneumonia.

Application of Machine Learning Methods to Analyze Occurrence and Clinical Features of Ascending Aortic Dilatation in Patients with and without Bicuspid Aortic Valve.

Aortic aneurysm (AA) rapture is one of the leading causes of death worldwide. Unfortunately, the diagnosis of AA is often verified after the onset of complications, in most cases after aortic rupture. The aim of this study was to evaluate the frequency of ascending aortic aneurysm (AscAA) and aortic dilatation (AD) in patients with cardiovascular diseases undergoing echocardiography, and to identify the main risk factors depending on the morphology of the aortic valve. We processed 84,851 echocardiographic (ECHO) records of 13,050 patients with aortic dilatation (AD) in the Almazov National Medical Research Centre from 2010 to 2018, using machine learning methodologies. Despite a high prevalence of AD, the main reason for the performed ECHO was coronary artery disease (CAD) and hypertension (HP) in 33.5% and 14.2% of the patient groups, respectively. The prevalence of ascending AD (>40 mm) was 15.4% (13,050 patients; 78.3% (10,212 patients) in men and 21.7% (2838 patients) in women). Only 1.6% (n = 212) of the 13,050 patients with AD knew about AD before undergoing ECHO in our center. Among all the patients who underwent ECHO, we identified 1544 (1.8%) with bicuspid aortic valve (BAV) and 635 with BAV had AD (only 4.8% of all AD patients). According to the results of the random forest feature importance analysis, we identified the eight main factors of AD: age, male sex, vmax aortic valve (AV), aortic stenosis (AS), blood pressure, aortic regurgitation (AR), diabetes mellitus, and heart failure (HF). The known factors of AD-like HP, CAD, hyperlipidemia, BAV, and obesity, were also AD risk factors, but were not as important. Our study showed a high frequency of AscAA and dilation. Standard risk factors of AscAA such as HP, hyperlipidemia, or obesity are significantly more common in patients with AD, but the main factors in the formation of AD are age, male sex, vmax AV, blood pressure, AS, AR, HF, and diabetes mellitus. In males with BAV, AD incidence did not differ significantly, but the presence of congenital heart disease was one of the 12 main risk factors for the formation of AD and association with more significant aortic dilatation in AscAA groups.

Three-stage intelligent support of clinical decision making for higher trust, validity, and explainability.

The paper presents a conceptual framework for building practically applicable clinical decision support systems (CDSSs) using data-driven (DD) predictive modelling. With the proposed framework we have tried to fill the gap between experimental CDSS implementations widely covered in the literature and solutions acceptable by physicians in daily practice. The framework is based on a three-stage approach where DD model definition is accomplished with practical norms referencing (scales, clinical recommendations, etc.) and explanation of the prediction results and recommendations. The approach is aimed at increasing the applicability of CDSSs based on DD models through better integration into decision context and higher explainability. The approach has been implemented in software solutions and tested within a case study in type 2 diabetes mellitus (T2DM) prediction, enabling us to improve known clinical scales (such as FINDRISK) while keeping the problem-specific reasoning interface similar to existing applications. A survey was performed to assess and investigate the acceptance level and provide insights on the influences of the introduced framework's element on physicians' behavior.

Assessing Acceptance Level of a Hybrid Clinical Decision Support Systems.

We present a user acceptance study of a clinical decision support system (CDSS) for Type 2 Diabetes Mellitus (T2DM) risk prediction. We focus on how a combination of data-driven and rule-based models influence the efficiency and acceptance by doctors. To evaluate the perceived usefulness, we randomly generated CDSS output in three different settings: Data-driven (DD) model output; DD model with a presence of known risk scale (FINDRISK); DD model with presence of risk scale and explanation of DD model. For each case, a physician was asked to answer 3 questions: if a doctor agrees with the result, if a doctor understands it, if the result is useful for the practice. We employed a Lankton's model to evaluate the user acceptance of the clinical decision support system. Our analysis has proved that without the presence of scales, a physician trust CDSS blindly. From the answers, we can conclude that interpretability plays an important role in accepting a CDSS.

Prediction model for thyrotoxic atrial fibrillation: a retrospective study.

BACKGROUND: Thyrotoxic atrial fibrillation (TAF) is a recognized significant complication of hyperthyroidism. Early identification of the individuals predisposed to TAF would improve thyrotoxic patients' management. However, to our knowledge, an instrument that establishes an individual risk of the condition is unavailable. Therefore, the aim of this study is to build a TAF prediction model and rank TAF predictors in order of importance using machine learning techniques. METHODS: In this retrospective study, we have investigated 36 demographic and clinical features for 420 patients with overt hyperthyroidism, 30% of which had TAF. At first, the association of these features with TAF was evaluated by classical statistical methods. Then, we developed several TAF prediction models with eight different machine learning classifiers and compared them by performance metrics. The models included ten features that were selected based on their clinical effectuality and importance for model output. Finally, we ranked TAF predictors, elicited from the optimal final model, by the machine learning tehniques. RESULTS: The best performance metrics prediction model was built with the extreme gradient boosting classifier. It had the reasonable accuracy of 84% and AUROC of 0.89 on the test set. The model confirmed such well-known TAF risk factors as age, sex, hyperthyroidism duration, heart rate and some concomitant cardiovascular diseases (arterial hypertension and conjestive heart rate). We also identified premature atrial contraction and premature ventricular contraction as new TAF predictors. The top five TAF predictors, elicited from the model, included (in order of importance) PAC, PVC, hyperthyroidism duration, heart rate during hyperthyroidism and age. CONCLUSIONS: We developed a machine learning model for TAF prediction. It seems to be the first available analytical tool for TAF risk assessment. In addition, we defined five most important TAF predictors, including premature atrial contraction and premature ventricular contraction as the new ones. These results have contributed to TAF prediction investigation and may serve as a basis for further research focused on TAF prediction improvement and facilitation of thyrotoxic patients' management.

Machine Learning-Based Factor Analysis of Carbohydrate Metabolism Compensation for TDM2 Patients.

Type 2 diabetes is one of the most common chronic diseases in the world. World Diabetes Federation experts predict that the diabetes patients' number by 2035 will increase by 205 million to reach 592 million. For health care, this diabetes type is one of the highest priority problems. This disease is associated with many concomitant diseases leading to early disability and high cardiovascular risk. A severity disease indicator is the degree of carbohydrate metabolism compensation. Decompensated and subcompensated carbohydrate metabolism patients have increased cardiovascular risks. Therefore, it is important to be able to select the right therapy to control carbohydrate metabolism. In this study, we propose a new method for selecting the optimal therapy automatically. The method includes creating personal optimal therapies. This kind of therapy has the highest probability of compensating carbohydrate metabolism for a patient within a six-month. The method includes models for predicting the results of different therapies. It is based on data from the previous medical history and current medical indicators of patients. This method provides high-quality predictions and medical recommendations. Therefore, medical professionals can use this method as part of the Support and Decision-Making Systems for working with T2DM patients.