Development and validation of a machine learning-based early prediction model for massive intraoperative bleeding in patients with primary hepatic malignancies

Table 1 Baseline characteristics of primary liver cancer patients in the training and prediction sets

	Training dataset (n = 284)			Testing dataset (n = 122)
	Non-hemorrhage (245)	Hemorrhage (39)	P value	Non-hemorrhage (96)	Hemorrhage (26)	P value
Gender, male, n (%)	195 (79.6)	32 (82.1)	0.888	77 (80.2)	20 (76.9)	0.925
Age (yr)	59.0 [52.0, 65.0]	55.0 [50.5, 62.0]	0.133	59.0 [53.0, 64.0]	59.0 [53.0, 66.0]	0.834
Alcohol, n (%)			0.024
No	151 (61.6)	16 (41.0)		58 (60.4)	15 (57.7)
Yes	94 (38.4)	23 (59.0)		38 (39.6)	11 (42.3)
Ascites, n (%)			< 0.001			0.001
No	237 (96.7)	29 (74.4)		94 (97.9)	20 (76.9)
Yes	8 (3.3)	10 (25.6)		2 (2.1)	6 (23.1)
Cirrhosis, n (%)			0.755			0.957
No	72 (29.4)	13 (33.3)		24 (25.0)	7 (26.9)
Yes	173 (70.6)	26 (66.7)		72 (75.0)	19 (73.1)
HBV, n (%)			0.061			0.957
No	67 (27.3)	17 (43.6)		24 (25.0)	7 (26.9)
Yes	178 (72.7)	22 (56.4)		72 (75.0)	19 (73.1)
HBG (g/L)	145.0 [133.6, 154.5]	139.0 [125.0, 154.0]	0.275	145.0 [135.0, 153.5]	134.0 [125.0, 146.0]	0.012
PT (s)	12.1 [11.5, 12.7]	12.0 [11.1, 12.6]	0.379	12.0 [11.4, 12.8]	11.9 [11.2, 13.1]	0.710
ALT (U/L)	27.0 [18.0, 40.0]	31.0 [23.0, 44.9]	0.100	29.7 [19.9, 49.0]	26.9 [20.8, 35.1]	0.332
AST (U/L)	27.0 [20.5, 40.0]	30.9 [26.1, 43.8]	0.053	26.9 [19.8, 41.0]	28.1 [22.8, 42.0]	0.524
Albumin (g/L)	42.7 [38.9, 45.5]	41.2 [36.7, 45.5]	0.274	43.3 [40.1, 45.6]	41.5 [37.8, 44.2]	0.075
TBIL (μmol/L)	13.3 [10.5, 17.9]	17.7 [13.3, 25.1]	0.001	13.6 [10.4, 17.1]	15.6 [11.9, 20.4]	0.086
DBIL (μmol/L)	5.0 [3.4, 7.0]	6.8 [4.2, 10.4]	0.002	4.9 [3.4, 6.7]	5.8 [3.5, 9.4]	0.314
IBIL (μmol/L)	8.1 [6.6, 11.4]	9.6 [6.8, 12.0]	0.152	8.4 [6.4, 10.8]	8.9 [7.1, 11.4]	0.440
AFP (ng/mL)	13.4 [4.2, 352.6]	10.6 [3.9, 365.6]	0.990	33.3 [4.9, 531.6]	77.7 [7.1, 571.7]	0.514
CEA (ng/mL)	2.6 [1.8, 4.1]	2.4 [1.6, 3.7]	0.498	2.6 [1.7, 3.7]	2.5 [2.1, 3.4]	0.883
No. of lesions, n (%)			0.462			0.534
1	205 (83.7)	35 (89.7)		83 (86.5)	21 (80.8)
> 1	40 (16.3)	4 (10.3)		13 (13.5)	5 (19.2)
Size of main tumor, n (%)			0.002			0.002
< 5 cm	144 (58.8)	12 (30.8)		58 (60.4)	6 (23.1)
≥ 5 cm	101 (41.2)	27 (69.2)		38 (39.6)	20 (76.9)
Tumor thrombus, n (%)			0.136			0.329
No	209 (85.3)	29 (74.4)		85 (88.5)	21 (80.8)
Yes	36 (14.7)	10 (25.6)		11 (11.5)	5 (19.2)
Pathological type, n (%)			0.760			0.558
HCC	207 (84.5)	31 (79.5)		80 (83.3)	22 (84.6)
CCA	32 (13.1)	7 (17.9)		10 (10.4)	4 (15.4)
HCC-CCA	2 (0.8)			3 (3.1)
Other	4 (1.6)	1 (2.6)		3 (3.1)
TNM, n (%)			< 0.001			< 0.001
I	175 (71.4)	11 (28.2)		70 (72.9)	9 (34.6)
II	38 (15.5)	6 (15.4)		13 (13.5)	4 (15.4)
III	27 (11.0)	19 (48.7)		10 (10.4)	12 (46.2)
IV	5 (2.0)	3 (7.7)		3 (3.1)	1 (3.8)
Child-Pugh grade, n (%)			0.002			0.021
A	234 (95.5)	31 (79.5)		92 (95.8)	21 (80.8)
B	11 (4.5)	8 (20.5)		4 (4.2)	5 (19.2)
ALBI score	-2.9 [-3.1, -2.5]	-2.7 [-3.1, -2.2]	0.108	-3.0 [-3.1, -2.6]	-2.8 [-3.0, -2.1]	0.059
ALBI grade, n (%)			< 0.001			0.398
1	177 (72.2)	21 (53.8)		73 (76.0)	17 (65.4)
2	68 (27.8)	16 (41.0)		23 (24.0)	9 (34.6)
3		2 (5.1)

HBV: Hepatitis B virus; HBG: Hemoglobin; PT: Prothrombin time; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Unconjugated bilirubin; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen; HCC: Hepatocellular carcinoma; CAA: Cholangio carcinoma; HCC-CCA: Combined hepatocellular-cholangiocarcinoma; ALBI: Albumin bilirubin.

Table 2 Results of multifactor analysis of variables associated with intraoperative bleeding in primary liver cancer patients

	97.5%CI lower	97.5%CI upper	OR	P value
Alcohol	1.231	7.068	2.950	0.015
Ascites	5.358	97.359	22.839	< 0.001
HBV	0.197	1.158	0.478	0.102
TBIL	0.947	1.456	1.174	0.144
DBIL	0.706	1.087	0.877	0.229
IBIL	0.725	1.144	0.911	0.421
Size of main tumor	0.865	5.798	2.239	0.097
Tumor thrombus	0.292	2.549	0.862	0.789
TNM	1.527	3.900	2.441	< 0.001
Child-Pugh_gr1de	0.035	1.402	0.223	0.11
ALBI score	1.426	3.909	2.361	0.001
ALBI grade	0.147	1.124	0.406	0.083
Age	0.879	1.091	0.979	0.384
AST	0.872	1.139	0.996	0.255
ALT	0.969	1.001	0.985	0.343

HBV: Hepatitis B virus; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Unconjugated bilirubin; ALBI: Albumin bilirubin.