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Development of a predictive risk model for all-cause mortality in patients with diabetes in Hong Kong
BMJ Open Diabetes Research & Care ( IF 4.1 ) Pub Date : 2021-06-01 , DOI: 10.1136/bmjdrc-2020-001950
Sharen Lee 1 , Jiandong Zhou 2 , Keith Sai Kit Leung 3 , William Ka Kei Wu 4 , Wing Tak Wong 5 , Tong Liu 6 , Ian Chi Kei Wong 7 , Kamalan Jeevaratnam 8 , Qingpeng Zhang 9 , Gary Tse 6, 8, 10, 11
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Introduction Patients with diabetes mellitus are risk of premature death. In this study, we developed a machine learning-driven predictive risk model for all-cause mortality among patients with type 2 diabetes mellitus using multiparametric approach with data from different domains. Research design and methods This study used territory-wide data of patients with type 2 diabetes attending public hospitals or their associated ambulatory/outpatient facilities in Hong Kong between January 1, 2009 and December 31, 2009. The primary outcome is all-cause mortality. The association of risk variables and all-cause mortality was assessed using Cox proportional hazards models. Machine and deep learning approaches were used to improve overall survival prediction and were evaluated with fivefold cross validation method. Results A total of 273 678 patients (mean age: 65.4±12.7 years, male: 48.2%, median follow-up: 142 (IQR=106–142) months) were included, with 91 155 deaths occurring on follow-up (33.3%; annualized mortality rate: 3.4%/year; 2.7 million patient-years). Multivariate Cox regression found the following significant predictors of all-cause mortality: age, male gender, baseline comorbidities, anemia, mean values of neutrophil-to-lymphocyte ratio, high-density lipoprotein-cholesterol, total cholesterol, triglyceride, HbA1c and fasting blood glucose (FBG), measures of variability of both HbA1c and FBG. The above parameters were incorporated into a score-based predictive risk model that had a c-statistic of 0.73 (95% CI 0.66 to 0.77), which was improved to 0.86 (0.81 to 0.90) and 0.87 (0.84 to 0.91) using random survival forests and deep survival learning models, respectively. Conclusions A multiparametric model incorporating variables from different domains predicted all-cause mortality accurately in type 2 diabetes mellitus. The predictive and modeling capabilities of machine/deep learning survival analysis achieved more accurate predictions. Data are available in a public, open access repository. Data are available on reasonable request. An anonymized version of the dataset has been deposited on Zenodo (), in fully compliance with University Regulations and Policy on Dataset Deposit and Sharing. For additional information: .
更新日期:2021-06-11
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