Artificial neural network is superior to MELD in predicting mortality of patients with end-stage liver disease
Artificial neural network is superior to MELD in predicting mortality of patients with end-stage liver disease
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DOI：
10.1136/gut.2005.084434
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发表时间：
2007-02-01
期刊：
影响因子：
24.5
通讯作者：
Pinna, A. D.
中科院分区：
文献类型：
--
作者：
Cucchetti, A.;Vivarelli, M.;Pinna, A. D.
背景：尽管目前用于确定肝硬化患者预后、指导移植计划转诊和优先分配供体器官的终末期肝病 (MELD) 模型准确，但无法预测相当大比例患者的死亡率。目的：评估使用人工神经网络 (ANN) 更好地预测等待肝移植患者 3 个月肝病相关死亡率的可能性。患者和方法：人工神经网络是使用来自 251 名连续患有肝病的患者的数据构建的。意大利博洛尼亚肝移植中心将患有肝硬化的患者列入肝移植名单。 ANN 经过训练，预测 188 名患者的 3 个月生存率，对系统未知的剩余 63 名患者（内部验证组）进行测试，最后对英国伦敦国王学院医院列出的 137 名肝移植患者（外部队列）进行测试。使用接受者操作特征 (ROC) 曲线 (AUC) 下的面积比较 ANN 和 MELD 在相同数据集上获得的生存预测。结果：在内部验证组（AUC = 0.95 v 0.85；p = 0.032）和外部队列（AUC = 0.96 v 0.86；p = 0.044）中，ANN 的表现均显着优于 MELD。结论：ANN比 MELD 更准确地测量肝硬化患者的死亡风险，并且可以更好地优先考虑肝移植候选者，从而降低等待名单中的死亡率。
Background: Despite its accuracy, the model for end-stage liver disease (MELD), currently adopted to determine the prognosis of patients with liver cirrhosis, guide referral to transplant programmes and prioritise the allocation of donor organs, fails to predict mortality in a considerable proportion of patients.Aims: To evaluate the possibility to better predict 3-month liver disease-related mortality of patients awaiting liver transplantation using an artificial neural network (ANN).Patients and methods: The ANN was constructed using data from 251 consecutive people with cirrhosis listed for liver transplantation at the Liver Transplant Unit, Bologna, Italy. The ANN was trained to predict 3-month survival on 188 patients, tested on the remaining 63 (internal validation group) unknown by the system and finally on 137 patients listed for liver transplantation at the King's College Hospital, London, UK (external cohort). Predictions of survival obtained with ANN and MELD on the same datasets were compared using areas under receiver-operating characteristic (ROC) curves (AUC).Results: The ANN performed significantly better than MELD both in the internal validation group (AUC = 0.95 v 0.85; p = 0.032) and in the external cohort (AUC = 0.96 v 0.86; p = 0.044).Conclusions: The ANN measured the mortality risk of patients with cirrhosis more accurately than MELD and could better prioritise liver transplant candidates, thus reducing mortality in the waiting list.