Risk factors and machine learning prediction models for bronchopulmonary dysplasia severity in the Chinese population

Abstract

Background: Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in extremely preterm neonates. The outcome and clinical burden vary dramatically according to severity. Although some prediction tools for BPD exist, they seldom pay attention to disease severity and are based on populations in developed countries. This study aimed to develop machine learning prediction models for BPD severity based on selected clinical factors in a Chinese population.

Methods: In this retrospective, single-center study, we included patients with a gestational age < 32 weeks who were diagnosed with BPD in our neonatal intensive care unit from 2016 to 2020. We collected their clinical information during the maternal, birth and early postnatal periods. Risk factors were selected through univariable and ordinal logistic regression analyses. Prediction models based on logistic regression (LR), gradient boosting decision tree, XGBoost (XGB) and random forest (RF) models were implemented and assessed by the area under the receiver operating characteristic curve (AUC).

Results: We ultimately included 471 patients (279 mild, 147 moderate, and 45 severe cases). On ordinal logistic regression, gestational diabetes mellitus, initial fraction of inspiration O₂ value, invasive ventilation, acidosis, hypochloremia, C-reactive protein level, patent ductus arteriosus and Gram-negative respiratory culture were independent risk factors for BPD severity. All the XGB, LR and RF models (AUC = 0.85, 0.86 and 0.84, respectively) all had good performance.

Conclusions: We found risk factors for BPD severity in our population and developed machine learning models based on them. The models have good performance and can be used to aid in predicting BPD severity in the Chinese population.

Keywords: Bronchopulmonary dysplasia; Machine learning; Prediction model; Preterm.

Fig. 1

Flow chart of the study showing the process of the model development, from the patients’ involvement and the filtration of risk factors to the development and assessment of prediction models based on the machine learning algorithm. BPD bronchopulmonary dysplasia

Fig. 2

Performance of different machine learning models showing the comparisons for different learning algorithms on test sets. a–d The ROC curves of the LR, GBDT, XGB and RF models. Class 1 represents mild BPD; class 2 represents moderate BPD, and class 3 represents severe BPD. LR logistic regression, RF random forest, GBDT gradient boost decision tree, ROC receiver operating characteristic, AUC area under the receiver operating characteristic curve, BPD bronchopulmonary dysplasia