Author information
1Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA. okan_ince@yahoo.com.
2Department of Radiology, Prof. Dr. Cemil TASCIOGLU City Hospital, Health Sciences University, Kaptanpasa Mah, Daruleceze Cad. No: 25 Prof. Dr. Cemil Tasçioglu Sehir Hastanesi, Radyoloji Klinigi, 34384, Sisli, Istanbul, Turkey.
3Department of Radiology, Medical School, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
4Department of Radiology, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.
Abstract
Purpose: To develop and assess machine learning (ML) models' ability to predict post-procedural hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement.
Materials and methods: In this retrospective study, 327 patients who underwent TIPS for hepatic cirrhosis between 2005 and 2019 were analyzed. Thirty features (8 clinical, 10 laboratory, 12 procedural) were collected, and HE development regardless of severity was recorded one month follow-up. Univariate statistical analysis was performed with numeric and categoric data, as appropriate. Feature selection is used with a sequential feature selection model with fivefold cross-validation (CV). Three ML models were developed using support vector machine (SVM), logistic regression (LR) and CatBoost, algorithms. Performances were evaluated with nested fivefold-CV technique.
Results: Post-procedural HE was observed in 105 (32%) patients. Patients with variceal bleeding (p = 0.008) and high post-porto-systemic pressure gradient (p = 0.004) had a significantly increased likelihood of developing HE. Also, patients having only one indication of bleeding or ascites were significantly unlikely to develop HE as well as Budd-Chiari disease (p = 0.03). The feature selection algorithm selected 7 features. Accuracy ratios for the SVM, LR and CatBoost, models were 74%, 75%, and 73%, with area under the curve (AUC) values of 0.82, 0.83, and 0.83, respectively.
Conclusion: ML models can aid identifying patients at risk of developing HE after TIPS placement, providing an additional tool for patient selection and management.