Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: Comparative analysis of three practical models

doi:10.3748/wjg.v28.i32.4681

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World Journal of Gastroenterology

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Retrospective Study

World J Gastroenterol. Aug 28, 2022; 28(32): 4681-4697
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4681

Table 1 Detailed clinical characteristics of 483 patients with portal hypertension

Variable	Training cohort			Validation cohort
Variable	Without PVT (n = 203)	PVT (n =135)	P value	Without PVT (n = 80)	PVT (n = 65)	P value
Sex, n (%)			0.312			0.86
Female	69 (34.0)	38 (28.1)		20 (25.0)	18 (27.7)
Male	134 (66.0)	97 (71.9)		60 (75.0)	47 (72.3)
Age, n (%)			0.179			0.999
< 60 yr	165 (81.3)	118 (87.4%)		71 (88.8)	58 (89.2)
≥ 60 yr	38 (18.7)	17 (12.6%)		9 (11.2)	7 (10.8)
Smoking, n (%)			0.703			0.983
No	167 (82.3)	108 (80.0)		64 (80.0)	51 (78.5)
Yes	36 (17.7)	27 (20.0)		16 (20.0)	14 (21.5)
Alcohol, n (%)			0.577			0.587
No	167 (82.3)	115 (85.2)		69 (86.2)	53 (81.5)
Yes	36 (17.7)	20 (14.8)		11 (13.8)	12 (18.5)
RBC¹ (× 10¹²/L)	3.59 (3.20-3.93)	3.57 (3.21-3.90)	0.69	3.74 (3.49-4.02)	3.55 (3.22-3.93)	0.044
HLB¹ (g/L)	89.3 (78.1-103)	93.2 (82.1-104)	0.093	89.5 (79.5-107)	91.1 (82.8-101)	0.965
WBC¹ (× 10⁹/L)	2.51 (1.83-3.40)	2.18 (1.48-2.87)	0.007	2.46 (1.95-3.21)	2.09 (1.58-2.92)	0.06
N¹ (× 10⁹/L)	1.35 (0.98-2.09)	1.27 (0.85-2.00)	0.177	1.38 (1.06-1.98)	1.15 (0.87-1.77)	0.147
L¹(× 10⁹/L)	0.79 (0.56-1.14)	0.50 (0.38-0.79)	< 0.001	0.78 (0.51-1.11)	0.63 (0.45-0.91)	0.045
NLR¹	1.78 (1.18-2.99)	2.43 (1.42-4.18)	0.003	1.90 (1.23-3.08)	2.16 (1.39-3.16)	0.559
PLT¹ (× 10⁹/L)	48.0 (36.0-64.5)	33.8 (26.0-47.9)	< 0.001	46.0 (32.1-57.0)	35.0 (27.0-48.0)	0.012
PLR¹	60.6 (43.4-97.0)	72.5 (35.0-99.7)	0.779	55.6 (37.9-91.3)	58.8 (31.8-86.8)	0.692
PT¹ (s)	15.5 (14.1-16.6)	15.3 (12.9-16.4)	0.221	15.7 (14.4-16.3)	15.3 (13.9-16.2)	0.294
PTA¹ (%)	64.0 (57.0-73.5)	60.0 (50.0-69.0)	< 0.001	67.0 (57.0-73.0)	63.0 (54.0-72.0)	0.269
INR¹	1.34 (1.23-1.47)	1.42 (1.29-1.62)	< 0.001	1.32 (1.23-1.50)	1.36 (1.23-1.50)	0.519
FIB¹ (g/L)	2.35 (1.62-3.86)	2.52 (1.82-3.78)	0.269	2.29 (1.74-4.14)	2.57 (1.83-3.62)	0.764
APTT¹ (s)	40.7 (37.5-44.8)	40.6 (36.9-44.9)	0.787	41.3 (37.9-44.3)	41.0 (38.5-44.1)	0.822
ALT¹ (U/L)	22.0 (16.0-30.5)	21.0 (15.0-28.0)	0.578	25.5 (17.8-40.0)	18.0 (15.0-27.0)	0.007
AST¹ (U/L)	29.0 (22.0-40.0)	25.0 (22.0-35.0)	0.021	30.5 (24.8-43.5)	25.0 (21.0-34.0)	0.009
ALB¹ (g/L)	35.9 (32.7-39.5)	35.8 (32.6-39.5)	0.881	35.7 (33.1-38.3)	36.4 (33.7-39.6)	0.551
TBIL¹ (μmol/L)	18.1 (12.4-24.6)	18.8 (12.4-27.0)	0.671	18.8 (13.6-24.6)	18.0 (14.4-26.1)	0.796
Child-Pugh grade, n (%)			0.644			0.999
A	146 (71.9)	101 (74.8)		58 (72.5)	48 (73.8)
B	57 (28.1)	34 (25.2)		22 (27.5)	17 (26.2)
EGV, n (%)			0.023			0.001
No	67 (33.0)	62 (45.9)		17 (21.2)	32 (49.2)
Yes	136 (67.0)	73 (54.1)		63 (78.8)	33 (50.8)
SPT¹ (cm)	5.50 (4.60-6.40)	6.40 (5.40-7.55)	< 0.001	5.70 (4.45-6.70)	6.30 (5.30-7.30)	0.034
DPV¹ (cm)	1.30 (1.10-1.40)	1.50 (1.25-1.70)	< 0.001	1.30 (1.10-1.50)	1.40 (1.20-1.60)	0.088
PBT, n (%)			0.126			0.023
No	159 (78.3)	95 (70.4)		67 (83.8)	43 (66.2)
Yes	44 (21.7)	40 (29.6)		13 (16.2)	22 (33.8)
De, n (%)			0.457			0.344
No	16 (7.88)	7 (5.19)		4 (5.00)	6 (9.23)
Yes	187 (92.1)	128 (94.8)		76 (95.0)	59 (90.8)
PLT1¹ (× 10⁹/L)	79.0 (61.0-106)	79.0 (64.0-102)	0.866	74.0 (57.7-93.8)	77.0 (61.0-102)	0.418
PLT3¹ (× 10⁹/L)	103 (78.5-158)	117 (85.0-164)	0.131	98.5 (75.5-140)	112 (81.0-156)	0.122
PPER1¹ (%)	0.59 (0.34-0.88)	1.18 (0.57-2.31)	< 0.001	0.70 (0.36-1.11)	0.87 (0.64-2.03)	0.002
PPER3¹ (%)	1.15 (0.62-2.02)	2.38 (1.52-3.87)	< 0.001	1.32 (0.79-2.04)	2.29 (1.36-3.54)	< 0.001

¹Continuous variables are presented as the median and interquartile range (IQR).

PH: Portal hypertension; PVT: Portal vein thrombosis; RBC: Red blood cells; HLB: Hemoglobin; WBC: White blood cells; N: Neutrophil count; L: Lymphocyte count; NLR: Neutrophil to lymphocyte ratio; PLT: Platelet count; PLR: Platelet to lymphocyte ratio; PT: Prothrombin time; PTA: Prothrombin activity; INR: International normalized ratio; FIB: Fibrinogen; APTT: Activated partial thromboplastin time; ALT: Alanine aminotransaminase; AST: Aspartate aminotransaminase; ALB: Serum albumin; TBIL: Total serum bilirubin; EGV: Esophageal and gastric varices; SPT: Spleen thickness; DPV: Diameter of the portal vein; PBT: Preoperative blood transfusion; De: Devascularization; PLT1: Platelet count at postoperative day 1; PLT3: Platelet count at postoperative day 3; PPER1: Platelet elevation rate at postoperative day 1; PPER3: Platelet elevation rate at postoperative day 3.

Table 2 Univariate and multivariate logistic regression analyses for risk factors associated with portal vein thrombosis in the overall cohort

Variable	Univariate		Multivariate¹
Variable	OR (95%CI)	P value	OR (95%CI)	P value
Sex (female vs male)	1.18 (0.79-1.76)	0.42
Age (< vs ≥ 60 yr)	0.68 (0.40-1.16)	0.16
Smoking (no vs yes)	1.15 (0.73-1.81)	0.56
Alcohol (no vs yes)	0.96 (0.59-1.56)	0.86
RBC² (× 10¹²/L)	0.71 (0.44-1.14)	0.16
HLB² (g/L)	1.01 (0.99-1.02)	0.22
WBC² (× 10⁹/L)	0.87 (0.76-1.00)	0.05
N² (× 10⁹/L)	1.05 (0.98-1.12)	0.20
L² (× 10⁹/L)	0.27 (0.16-0.45)	< 0.001	0.28 (0.14-0.54)	< 0.001
NLR²	1.07 (1.01-1.14)	0.03	1.03 (0.98-1.11)	0.42
PLT² (× 10⁹/L)	0.98 (0.97-0.99)	< 0.001	0.99 (0.98-1.01)	0.98
PLR²	1.00 (1.00-1.00)	0.18
PT² (s)	0.94 (0.89-1.00)	0.07
PTA² (%)	0.97 (0.96-0.99)	< 0.001	0.99 (0.98-1.02)	0.73
INR²	0.98 (0.88-1.09)	0.74
FIB² (g/L)	1.06 (0.93-1.21)	0.42
APTT²(s)	0.99 (0.96-1.01)	0.38
ALT² (U/L)	0.99 (0.98-1.00)	0.16
AST² (U/L)	0.98 (0.97-0.99)	< 0.001	0.99 (0.98-1.00)	0.14
ALB² (g/L)	1.00 (0.97-1.04)	0.97
TBIL² (μmol/L)	1.00 (0.99-1.02)	0.78
Child-Pugh (A vs B)	0.88 (0.59-1.33)	0.56
EGV (no vs yes)	0.48 (0.33-0.69)	< 0.001	0.51 (0.32-0.79)	0.003
SPT² (cm)	1.34 (1.19-1.50)	< 0.001	1.22 (1.06-1.40)	0.005
DPV² (cm)	4.72 (2.69-8.29)	< 0.001	3.57 (1.86-7.03)	< 0.001
PBT (no vs yes)	1.78 (1.17-2.70)	0.01	1.33 (0.79-2.26)	0.28
De (no vs yes)	1.09 (0.53-2.25)	0.81
PLT1² (× 10⁹/L)	1.00 (0.99-1.00)	0.32
PLT3² (× 10⁹/L)	1.00 (1.00-1.00)	0.25
PPER² (%)	2.77 (2.1-3.66)	< 0.001	1.78 (1.24-2.62)	0.002
PPER3² (%)	1.86 (1.58-2.19)	< 0.001	1.43 (1.16-1.77)	< 0.001

¹Forward stepwise analysis.

²Continuous variables.

PVT: Portal vein thrombosis; OR: Odds ratio; CI: Confidence interval; RBC: Red blood cells; HLB: Hemoglobin; WBC: White blood cells; N: Neutrophil count; L: Lymphocyte count; NLR: Neutrophil to lymphocyte ratio; PLT: Platelet count; PLR: Platelet to lymphocyte ratio; PT: Prothrombin time; PTA: Prothrombin activity; INR: International normalized ratio; FIB: Fibrinogen; APTT: Activated partial thromboplastin time; ALT: Alanine aminotransaminase; AST: Aspartate aminotransaminase; ALB: Serum albumin; TBIL: Total serum bilirubin; EGV: Esophageal and gastric varices; SPT: Spleen thickness; DPV: Diameter of the portal vein; PBT: Preoperative blood transfusion; De: Devascularization; PLT1: Platelet count at postoperative day 1; PLT3: Platelet count at postoperative day 3; PPER1: Platelet elevation rate at postoperative day 1; PPER3: Platelet elevation rate at postoperative day 3.

Table 3 Performance of models for portal vein thrombosis risk prediction in different cohorts

	AUC (95%CI)	Sensitivity (95%CI)	Specificity (95%CI)	PPV (95%CI)	NPV (95%CI)	Accuracy (%)	F1	Kappa	Brier
Overall cohort
GLM	0.812 (0.773-0.851)	0.710 (0.642-0.772)	0.799 (0.747-0.844)	0.714 (0.650-0.775)	0.796 (0.740-0.841)	76.2	0.712	0.509	0.169
LSM	0.822 (0.784-0.861)	0.640 (0.569-0.706)	0.869 (0.824-0.906)	0.776 (0.709-0.824)	0.774 (0.718-0.832)	77.4	0.701	0.522	0.163
RFM	0.814 (0.775-0.854)	0.665 (0.595-0.730)	0.852 (0.805-0.891)	0.760 (0.695-0.812)	0.782 (0.727-0.837)	77.4	0.709	0.526	0.168
Training cohort
GLM	0.833 (0.787-0.879)	0.674 (0.588-0.752)	0.877 (0.824-0.919)	0.784 (0.705-0.842)	0.802 (0.736-0.865)	79.6	0.725	0.564	0.157
LSM	0.839 (0.794-0.884)	0.733 (0.650-0.806)	0.828 (0.768-0.877)	0.739 (0.662-0.810)	0.824 (0.759-0.874)	79.0	0.736	0.562	0.153
RFM	0.838 (0.793-0.883)	0.756 (0.674-0.825)	0.808 (0.747-0.860)	0.723 (0.647-0.800)	0.832 (0.769-0.879)	78.7	0.739	0.559	0.154
Validation cohort
GLM	0.769 (0.691-0.846)	0.646 (0.518-0.761)	0.825 (0.724-0.901)	0.750 (0.625-0.839)	0.742 (0.628-0.847)	74.5	0.694	0.477	0.190
LSM	0.826 (0.755-0.897)	0.708 (0.582-0.814)	0.863 (0.767-0.929)	0.807 (0.687-0.883)	0.784 (0.676-0.884)	79.3	0.754	0.577	0.163
RFM	0.777 (0.700-0.853)	0.631 (0.502-0.747)	0.875 (0.782-0.938)	0.804 (0.678-0.876)	0.745 (0.632-0.864)	76.6	0.707	0.516	0.187

AUC: Area under the receiver operating characteristics curve; CI: Confidence interval; PPV: Positive predictive value; NPV: Negative predictive value; GLM: Generalized linear model; LSM: Least absolute shrinkage and selection operator model; RFM: Random forest model.

Citation: Li J, Wu QQ, Zhu RH, Lv X, Wang WQ, Wang JL, Liang BY, Huang ZY, Zhang EL. Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: Comparative analysis of three practical models. World J Gastroenterol 2022; 28(32): 4681-4697
URL: https://www.wjgnet.com/1007-9327/full/v28/i32/4681.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i32.4681