Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters

Abstract

Purpose: To validate a clinical decision support system (CDSS) that estimates risk of diabetic retinopathy (DR) and to personalize screening protocols in type 2 diabetes mellitus (T2DM) patients.

Methods: We utilized a CDSS based on a fuzzy random forest, integrated by fuzzy decision trees with the following variables: current age, sex, arterial hypertension, diabetes duration and treatment, HbA1c, glomerular filtration rate, microalbuminuria, and body mass index. Validation was made using the electronic health records of a sample of 101,802 T2DM patients. Diagnosis was made by retinal photographs, according to EURODIAB guidelines and the International Diabetic Retinopathy Classification.

Results: The prevalence of DR was 19,759 patients (19.98%). Results yielded 16,593 (16.31%) true positives, 72,617 (71.33%) true negatives, 3165 (3.1%) false positives, and 9427 (9.26%) false negatives, with an accuracy of 0.876 (95% confidence interval [CI], 0.858-0.886), sensitivity of 84% (95% CI, 83.46-84.49), specificity of 88.5% (95% CI, 88.29-88.72), positive predictive value of 63.8% (95% CI, 63.18-64.35), negative predictive value of 95.8% (95% CI, 95.68-95.96), positive likelihood ratio of 7.30, and negative likelihood ratio of 0.18. The type 1 error was 0.115, and the type 2 error was 0.16.

Conclusions: We confirmed a good prediction rate for DR from a representative sample of T2DM in our population. Furthermore, the CDSS was able to offer an individualized screening protocol for each patient according to the calculated risk confidence value.

Translational relevance: Results from this study will help to establish a novel strategy for personalizing screening for DR according to patient risk factors.

Figure.

Example of CDSS. Top, an example of a patient at risk of DR; bottom, an example of non-DR risk and the next visit personalized at 36 months.