Application of machine learning methods for predicting esophageal variceal bleeding in patients with cirrhosis

To develop and compare machine learning models based on CT morphology features, serum biomarkers, and basic physical conditions to predict esophageal variceal bleeding.

Two hundred twenty-four cirrhotic patients with esophageal variceal bleeding and non-bleeding were included in the retrospective study. Clinical and serum biomarkers were used in our study. In addition, the open-access segmentation model was used to generate segmentation masks of the liver and spleen. Four machine learning models based on selected features are used for building prediction models, and the diagnostic performances of models were measured using the receiver operator characteristic analysis.

Two hundred twenty-four cirrhosis patients with esophageal varices, including 112 patients with bleeding (mean age 52.8 ± 11.5 years, range 18-80 years) and 112 patients with non-bleeding (mean age 57.3 ± 10.5 years, range 34-85 years). The two groups showed significant differences in standardized spleen volume, fibrinogen, alanine aminotransferase, aspartate aminotransferase, D-dimer, platelet, and age. The ratio of the training set to the test set was 8:2 in our research, and the 5-fold cross-validation was used in the research. The AUCs of linear regression, random forest, support vector machine, and adaptive boosting were, respectively, 0.742, 0.854, 0.719, and 0.821 in the training set. For the test set, the AUCs of models were, respectively, 0.763, 0.818, 0.648, and 0.804.

Our study used CT morphological measurements, serum biomarkers, and age to build machine learning models, and the random forest and adaptive boosting had potential added value in predictive model construction.

Question Esophageal variceal bleeding is an intractable complication of liver cirrhosis. Early prediction and prevention of esophageal variceal bleeding is important for patients with liver cirrhosis. Findings It was feasible and clinically meaningful to construct machine learning models based on CT morphology features, serum biomarkers, and physical conditions to predict variceal bleeding. Clinical relevance Our study may provide a promising tool with which clinicians can conduct therapeutic decisions on fewer invasive procedures for the prediction of esophageal variceal bleeding.