Predicting the timing of LC after PTGBD in elderly patients with acute cholecystitis: a machine learning approach...

Transcutaneous transhepatic gallbladder drainage (PTGBD) has shown significant efficacy in the treatment of elderly patients with acute cholecystitis. The goal of this study is to develop a machine learning-based web calculator aimed at predicting the optimal timing for cholecystectomy (LC) after PTGBD in elderly patients with acute cholecystitis (AC) to achieve precise personalized medicine.

A retrospective analysis of 979 elderly patients with acute cholecystitis admitted to Jinzhou Central Hospital and the First Affiliated Hospital of Jinzhou Medical University from 2013 to 2024 was performed, and a total of 680 patients were included in the model development. Patients were divided into delayed (347 cases, surgery > 6 weeks post-PTGBD) and non-delayed (333 cases) groups based on the interval between PTGBD and LC. Minimal Absolute Contraction and Selection Operator (LASSO) and logistic analysis were used to determine the predictors of postponement of LC in elderly patients with AC after PTGBD. Next, we used eight ML algorithms, namely Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Extreme gradient boosting (XGB), Support Vector Machine (SVM), Multilayer Perceptron (MLP), K-nearest Neighbor (KNN), Gaussian Naive Bayes (GNB), to train and develop ML models using a 10x cross-validation method. The performance of the model was evaluated by a variety of indicators, including the area under the receiver operating characteristic curve (ROC), calibration curve, decision curve, PR curve, and confusion matrix. In addition, model interpretation is performed through Shapley Additive Interpretation (SHAP) analysis to clarify the importance of each feature of the model and its basis for decision-making. Finally, we chose to use the best model to develop a web-based calculator that could be used to predict the likelihood of delaying LC after PTGBD in elderly AC patients.

In multivariate logistic regression analysis, age, sex, gallbladder wall thickness, time between onset and PTGBD, white blood cell count (WBC), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were identified as independent predictors of delayed LC in elderly patients with AC after PTGBD. In the training set, the area under the receiver operating characteristic curve (AUC) values for these models ranged from 0.808 to 0.914, with the random forest (RF) model showing the highest AUC value. Through the evaluation of decision curve analysis (DCA), precision-recall (PR) curve and calibration curve, the RF model showed superior clinical decision support and prediction performance compared with the other seven models. Finally, we used the RF model to build an online network calculator, which aims to accurately assist doctors in making more informed and accurate clinical decisions and promote the wide application of the model in clinical practice ( https://zw17786325639.shinyapps.io/Postpone/ ).

This study developed and validated an RF model network calculator based on clinical indicator information to assess the likelihood of delaying LC after PTGBD in elderly patients with acute cholecystitis. This tool is expected to assist physicians in making more appropriate clinical decisions for patients.