학술논문
MALrisk: a machne-learning based tool to predict imported malaria in returned travellers with fever.
Document Type
Academic Journal
Author
Balerdi-Sarasola L; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Pedro F; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Bottieau E; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.; Genton B; Center for Primary Care and Public Health, University of Lausanne, Switzerland.; Petrone P; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Muñoz J; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Camprubí-Ferrer D; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 9434456 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1708-8305 (Electronic) Linking ISSN: 11951982 NLM ISO Abbreviation: J Travel Med Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Early diagnosis is key to reducing the morbi-mortality associated with P. falciparum malaria among international travellers. However, access to microbiological tests can be challenging for some healthcare settings. Artificial Intelligence could improve the management of febrile travellers.
Methods: Data from a multicentric prospective study of febrile travellers was obtained to build a machine-learning model to predict malaria cases among travellers presenting with fever. Demographic characteristics, clinical and laboratory variables were leveraged as features. Eleven machine-learning classification models were evaluated by 50-fold cross-validation in a Training set. Then, the model with the best performance, defined by the Area Under the Curve (AUC), was chosen for parameter optimization and evaluation in the Test set. Finally, a reduced model was elaborated with those features that contributed most to the model.
Results: Out of eleven machine-learning models, XGBoost presented the best performance (mean AUC of 0.98 and a mean F1 score of 0.78). A reduced model (MALrisk) was developed using only six features: Africa as a travel destination, platelet count, rash, respiratory symptoms, hyperbilirubinemia and chemoprophylaxis intake. MALrisk predicted malaria cases with 100% (95%CI 96-100) sensitivity and 72% (95%CI 68-75) specificity.
Conclusions: The MALrisk can aid in the timely identification of malaria in non-endemic settings, allowing the initiation of empiric antimalarials and reinforcing the need for urgent transfer in healthcare facilities with no access to malaria diagnostic tests. This resource could be easily scalable to a digital application and could reduce the morbidity associated with late diagnosis.
(© The Author(s) 2024. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Methods: Data from a multicentric prospective study of febrile travellers was obtained to build a machine-learning model to predict malaria cases among travellers presenting with fever. Demographic characteristics, clinical and laboratory variables were leveraged as features. Eleven machine-learning classification models were evaluated by 50-fold cross-validation in a Training set. Then, the model with the best performance, defined by the Area Under the Curve (AUC), was chosen for parameter optimization and evaluation in the Test set. Finally, a reduced model was elaborated with those features that contributed most to the model.
Results: Out of eleven machine-learning models, XGBoost presented the best performance (mean AUC of 0.98 and a mean F1 score of 0.78). A reduced model (MALrisk) was developed using only six features: Africa as a travel destination, platelet count, rash, respiratory symptoms, hyperbilirubinemia and chemoprophylaxis intake. MALrisk predicted malaria cases with 100% (95%CI 96-100) sensitivity and 72% (95%CI 68-75) specificity.
Conclusions: The MALrisk can aid in the timely identification of malaria in non-endemic settings, allowing the initiation of empiric antimalarials and reinforcing the need for urgent transfer in healthcare facilities with no access to malaria diagnostic tests. This resource could be easily scalable to a digital application and could reduce the morbidity associated with late diagnosis.
(© The Author(s) 2024. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)