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APASL-ACLF Research Consortium-Artificial Intelligence (AARC-AI) model precisely predicts outcomes in acute-on-chronic liver failure patients

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单位: [1]Postgrad Inst Med Educ & Res, Dept Hepatol, Chandigarh, India [2]Inst Liver & Biliary Sci, Dept Hepatol, New Delhi, India [3]Bangabandhu Sheikh Mujib Med Univ, Dept Hepatol, Dhaka, Bangladesh [4]St John Med Coll, Dept Hepatol, Bangalore, Karnataka, India [5]CMC, Dept Hepatol, Vellore, Tamil Nadu, India [6]Huazhong Univ Sci & Technol,Inst & Dept Infect Dis,Tongji Med Coll,Tongji Hosp,Wuhan,Peoples R China [7]Capital Med Univ, Beijing Youan Hosp, Translat Hepatol Inst, Beijing, Peoples R China [8]Aga Khan Univ Hosp, Dept Med, Karachi, Pakistan [9]Lokmanya Tilak Municipal Gen Hosp, Dept Gastroenterol, Mumbai, Maharashtra, India [10]Lokmanya Tilak Municipal Gen Hosp & Med Coll, Mumbai, Maharashtra, India [11]Hosp Selayang, Dept Med, Batu Caves, Selangor, Malaysia [12]Hallym Univ, Coll Med, Dept Internal Med, Seoul, South Korea [13]302 Mil Hosp, Dept Med, Beijing, Peoples R China [14]DMC, Dept Gastroenterol, Ludhiana, Punjab, India [15]Nork Clin Hosp Infect Dis, Dept Hepatol, Yerevan, Armenia [16]IMS & SUM Hosp, Dept Gastroenterol & Hepatol Sci, Bhubaneswar, India [17]Natl Univ Hlth Syst, Div Gastroenterol & Hepatol, Dept Med, Singapore, Singapore [18]Chulalongkorn Univ, Dept Med, Bangkok, Thailand [19]Global Hosp, Mumbai, Maharashtra, India [20]Medistra Hosp, Digest Dis & GI Oncol Ctr, Jakarta, Indonesia [21]VGM Hosp, Dept Gastroenterol, Coimbatore, Tamil Nadu, India
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关键词: cirrhosis data science machine learning mortality prognosis

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Background and Aims: We hypothesized that artificial intelligence (AI) models are more precise than standard models for predicting outcomes in acute-on-chronic liver failure (ACLF). Methods: We recruited ACLF patients between 2009 and 2020 from APASL-ACLF Research Consortium (AARC). Their clinical data, investigations and organ involvement were serially noted for 90-days and utilized for AI modelling. Data were split randomly into train and validation sets. Multiple AI models, MELD and AARC-Model, were created/optimized on train set. Outcome prediction abilities were evaluated on validation sets through area under the curve (AUC), accuracy, sensitivity, specificity and class precision. Results: Among 2481 ACLF patients, 1501 in train set and 980 in validation set, the extreme gradient boost-cross-validated model (XGB-CV) demonstrated the highest AUC in train (0.999), validation (0.907) and overall sets (0.976) for predicting 30-day outcomes. The AUC and accuracy of the XGB-CV model (%Delta) were 7.0% and 6.9% higher than the standard day-7 AARC model (p < .001) and 12.8% and 10.6% higher than the day 7 MELD for 30-day predictions in validation set (p < .001). The XGB model had the highest AUC for 7- and 90-day predictions as well (p < .001). Day-7 creatinine, international normalized ratio (INR), circulatory failure, leucocyte count and day-4 sepsis were top features determining the 30-day outcomes. A simple decision tree incorporating creatinine, INR and circulatory failure was able to classify patients into high (similar to 90%), intermediate (similar to 60%) and low risk (similar to 20%) of mortality. A web-based AARC-AI model was developed and validated twice with optimal performance for 30-day predictions. Conclusions: The performance of the AARC-AI model exceeds the standard models for outcome predictions in ACLF. An AI-based decision tree can reliably undertake severity-based stratification of patients for timely interventions.

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出版当年[2022]版:
大类 | 2 区 医学
小类 | 2 区 胃肠肝病学
最新[2025]版:
大类 | 2 区 医学
小类 | 3 区 胃肠肝病学
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出版当年[2021]版:
Q1 GASTROENTEROLOGY & HEPATOLOGY
最新[2023]版:
Q1 GASTROENTEROLOGY & HEPATOLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

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第一作者单位: [1]Postgrad Inst Med Educ & Res, Dept Hepatol, Chandigarh, India
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