Computational platform for doctor-artificial intelligence cooperation in pulmonary arterial hypertension prognostication: a pilot study

Authors

Vitaly O. Kheyfets, Paediatric Critical Care Medicine, Developmental Lung Biology and CVP Research Laboratories, School of Medicine, University of Colorado, Aurora, CO, USA.
Andrew J. Sweatt, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.
Mardi Gomberg-Maitland, Division of Cardiology, George Washington University Hospital, Washington, DC, USA.
Dunbar D. Ivy, Department of Paediatric Cardiology, Children's Hospital Colorado, Aurora, CO, USA.
Robin Condliffe, Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.
David G. Kiely, Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.
Allan Lawrie, Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.
Bradley A. Maron, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, MA, USA.
Roham T. Zamanian, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.
Kurt R. Stenmark, Paediatric Critical Care Medicine, Developmental Lung Biology and CVP Research Laboratories, School of Medicine, University of Colorado, Aurora, CO, USA.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

ERJ open research

Volume

9

Issue

1

DOI

10.1183/23120541.00484-2022

Abstract

BACKGROUND: Pulmonary arterial hypertension (PAH) is a heterogeneous and complex pulmonary vascular disease associated with substantial morbidity. Machine-learning algorithms (used in many PAH risk calculators) can combine established parameters with thousands of circulating biomarkers to optimise PAH prognostication, but these approaches do not offer the clinician insight into what parameters drove the prognosis. The approach proposed in this study diverges from other contemporary phenotyping methods by identifying patient-specific parameters driving clinical risk. METHODS: We trained a random forest algorithm to predict 4-year survival risk in a cohort of 167 adult PAH patients evaluated at Stanford University, with 20% withheld for (internal) validation. Another cohort of 38 patients from Sheffield University were used as a secondary (external) validation. Shapley values, borrowed from game theory, were computed to rank the input parameters based on their importance to the predicted risk score for the entire trained random forest model (global importance) and for an individual patient (local importance). RESULTS: Between the internal and external validation cohorts, the random forest model predicted 4-year risk of death/transplant with sensitivity and specificity of 71.0-100% and 81.0-89.0%, respectively. The model reinforced the importance of established prognostic markers, but also identified novel inflammatory biomarkers that predict risk in some PAH patients. CONCLUSION: These results stress the need for advancing individualised phenotyping strategies that integrate clinical and biochemical data with outcome. The computational platform presented in this study offers a critical step towards personalised medicine in which a clinician can interpret an algorithm's assessment of an individual patient.

APA Citation

Kheyfets, Vitaly O.; Sweatt, Andrew J.; Gomberg-Maitland, Mardi; Ivy, Dunbar D.; Condliffe, Robin; Kiely, David G.; Lawrie, Allan; Maron, Bradley A.; Zamanian, Roham T.; and Stenmark, Kurt R., "Computational platform for doctor-artificial intelligence cooperation in pulmonary arterial hypertension prognostication: a pilot study" (2023). GW Authored Works. Paper 2435.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2435

Department

Medicine