The prediction of asymptomatic carotid atherosclerosis with electronic health records: a comparative study of six machine learning models

• Published in: BMC medical informatics and decision making Vol. 21; no. 1; pp. 115 - 9
• Main Authors: Fan, Jiaxin, Chen, Mengying, Luo, Jian, Yang, Shusen, Shi, Jinming, Yao, Qingling, Zhang, Xiaodong, Du, Shuang, Qu, Huiyang, Cheng, Yuxuan, Ma, Shuyin, Zhang, Meijuan, Xu, Xi, Wang, Qian, Zhan, Shuqin
• Format: Journal Article
• Language: English
• Published: London BioMed Central 05.04.2021; BioMed Central Ltd; BMC
• Subjects: Accuracy; Algorithms; Analysis; Arteriosclerosis; Asymptomatic; Asymptomatic carotid atherosclerosis; Atherosclerosis; Bayes Theorem; Bayesian analysis; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - epidemiology; Comparative studies; Decision trees; Diagnosis; Discriminant analysis; Electronic Health Records; Electronic medical records; Electronic records; Evaluation; Health Informatics; Humans; Identification methods; Information Systems and Communication Service; Ischemia; Learning algorithms; Machine Learning; Management of Computing and Information Systems; Medical records; Medicine; Medicine & Public Health; Model testing; Patients; Performance evaluation; Performance prediction; Prediction; Predictions; Regression analysis; Research Article; Retrospective Studies; Ultrasonic imaging; China; Japan; Asymptomatic carotid atherosclerosis; Electronic health records; Machine learning; Prediction
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-021-01480-3

Background Screening carotid B-mode ultrasonography is a frequently used method to detect subjects with carotid atherosclerosis (CAS). Due to the asymptomatic progression of most CAS patients, early identification is challenging for clinicians, and it may trigger ischemic stroke. Recently, machine learning has shown a strong ability to classify data and a potential for prediction in the medical field. The combined use of machine learning and the electronic health records of patients could provide clinicians with a more convenient and precise method to identify asymptomatic CAS. Methods Retrospective cohort study using routine clinical data of medical check-up subjects from April 19, 2010 to November 15, 2019. Six machine learning models (logistic regression [LR], random forest [RF], decision tree [DT], eXtreme Gradient Boosting [XGB], Gaussian Naïve Bayes [GNB], and K-Nearest Neighbour [KNN]) were used to predict asymptomatic CAS and compared their predictability in terms of the area under the receiver operating characteristic curve (AUCROC), accuracy (ACC), and F1 score (F1). Results Of the 18,441 subjects, 6553 were diagnosed with asymptomatic CAS. Compared to DT (AUCROC 0.628, ACC 65.4%, and F1 52.5%), the other five models improved prediction: KNN + 7.6% (0.704, 68.8%, and 50.9%, respectively), GNB + 12.5% (0.753, 67.0%, and 46.8%, respectively), XGB + 16.0% (0.788, 73.4%, and 55.7%, respectively), RF + 16.6% (0.794, 74.5%, and 56.8%, respectively) and LR + 18.1% (0.809, 74.7%, and 59.9%, respectively). The highest achieving model, LR predicted 1045/1966 cases (sensitivity 53.2%) and 3088/3566 non-cases (specificity 86.6%). A tenfold cross-validation scheme further verified the predictive ability of the LR. Conclusions Among machine learning models, LR showed optimal performance in predicting asymptomatic CAS. Our findings set the stage for an early automatic alarming system, allowing a more precise allocation of CAS prevention measures to individuals probably to benefit most.