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2024 ; 7
(ä): e54872
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Development and Validation of an Explainable Machine Learning Model for
Predicting Myocardial Injury After Noncardiac Surgery in Two Centers in China:
Retrospective Study
#MMPMID39087583
Liu C
; Zhang K
; Yang X
; Meng B
; Lou J
; Liu Y
; Cao J
; Liu K
; Mi W
; Li H
JMIR Aging
2024[Jul]; 7
(ä): e54872
PMID39087583
show ga
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is an easily
overlooked complication but closely related to postoperative cardiovascular
adverse outcomes; therefore, the early diagnosis and prediction are particularly
important. OBJECTIVE: We aimed to develop and validate an explainable machine
learning (ML) model for predicting MINS among older patients undergoing
noncardiac surgery. METHODS: The retrospective cohort study included older
patients who had noncardiac surgery from 1 northern center and 1 southern center
in China. The data sets from center 1 were divided into a training set and an
internal validation set. The data set from center 2 was used as an external
validation set. Before modeling, the least absolute shrinkage and selection
operator and recursive feature elimination methods were used to reduce dimensions
of data and select key features from all variables. Prediction models were
developed based on the extracted features using several ML algorithms, including
category boosting, random forest, logistic regression, naïve Bayes, light
gradient boosting machine, extreme gradient boosting, support vector machine, and
decision tree. Prediction performance was assessed by the area under the receiver
operating characteristic (AUROC) curve as the main evaluation metric to select
the best algorithms. The model performance was verified by internal and external
validation data sets with the best algorithm and compared to the Revised Cardiac
Risk Index. The Shapley Additive Explanations (SHAP) method was applied to
calculate values for each feature, representing the contribution to the predicted
risk of complication, and generate personalized explanations. RESULTS: A total of
19,463 eligible patients were included; among those, 12,464 patients in center 1
were included as the training set; 4754 patients in center 1 were included as the
internal validation set; and 2245 in center 2 were included as the external
validation set. The best-performing model for prediction was the CatBoost
algorithm, achieving the highest AUROC of 0.805 (95% CI 0.778-0.831) in the
training set, validating with an AUROC of 0.780 in the internal validation set
and 0.70 in external validation set. Additionally, CatBoost demonstrated superior
performance compared to the Revised Cardiac Risk Index (AUROC 0.636; P<.001). The
SHAP values indicated the ranking of the level of importance of each variable,
with preoperative serum creatinine concentration, red blood cell distribution
width, and age accounting for the top three. The results from the SHAP method can
predict events with positive values or nonevents with negative values, providing
an explicit explanation of individualized risk predictions. CONCLUSIONS: The ML
models can provide a personalized and fairly accurate risk prediction of MINS,
and the explainable perspective can help identify potentially modifiable sources
of risk at the patient level.