An Explainable Predictive Machine Learning Model of Gangrenous Cholecystitis Based on Clinical Data: a Retrospective Single Center Study

Overview

Journal World J Emerg Surg

Publisher Biomed Central

Specialty General Surgery

Date 2025 Jan 5

PMID 39757162

Authors

Ying Ma

Man Luo

Guoxin Guan

Xingming Liu

Xingye Cui

Fuwen Luo

Affiliations

Soon will be listed here.

Abstract

Background: Gangrenous cholecystitis (GC) is a serious clinical condition associated with high morbidity and mortality rates. Machine learning (ML) has significant potential in addressing the diverse characteristics of real data. We aim to develop an explainable and cost-effective predictive model for GC utilizing ML and Shapley Additive explanation (SHAP) algorithm.

Results: This study included a total of 1006 patients with 26 clinical features. Through 5-fold CV, the best performing integrated learning model, XGBoost, was identified. The model was interpreted using SHAP to derive the feature subsets WBC, NLR, D-dimer, Gallbladder width, Fibrinogen, Gallbladder wallness, Hypokalemia or hyponatremia, these subsets comprised the final diagnostic prediction model.

Conclusions: The study developed a explainable predictive tool for GC at an early stage. This could assist doctors to make quick surgical intervention decisions and perform surgery on patients with GC as soon as possible.

References

Bourikian S, Anand R, Aboutanos M, Wolfe L, Ferrada P . Risk factors for acute gangrenous cholecystitis in emergency general surgery patients. Am J Surg. 2015; 210(4):730-3. DOI: 10.1016/j.amjsurg.2015.05.003. View

Alghamdi K, Rizk H, Jamal W, Bakhshween A, Maqboul A, Saggaf A . Risk Factors of Gangrenous Cholecystitis in General Surgery Patient Admitted for Cholecystectomy in King Abdul-Aziz University Hospital (KAUH), Saudi Arabia. Mater Sociomed. 2020; 31(4):286-289. PMC: 7007620. DOI: 10.5455/msm.2019.31.286-289. View

Siada S, Jeffcoach D, Dirks R, Wolfe M, Kwok A, Sue L . A predictive grading scale for acute cholecystitis. Trauma Surg Acute Care Open. 2019; 4(1):e000324. PMC: 6660796. DOI: 10.1136/tsaco-2019-000324. View

Zhang H, Zeng L, Xie M, Liu J, Zhou B, Wu R . TMEM173 Drives Lethal Coagulation in Sepsis. Cell Host Microbe. 2020; 27(4):556-570.e6. PMC: 7316085. DOI: 10.1016/j.chom.2020.02.004. View

Uemura S, Higuchi R, Yazawa T, Izumo W, Sugishita T, Morita S . Impact of transient hepatic attenuation differences on computed tomography scans in the diagnosis of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Sci. 2019; 26(8):348-353. DOI: 10.1002/jhbp.637. View

Akyildiz H, Sozuer E, Akcan A, Kucuk C, Artis T, Biri I . The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen. Ulus Travma Acil Cerrahi Derg. 2010; 16(1):22-6. View

Bouassida M, Madhioub M, Kallel Y, Zribi S, Slama H, Mighri M . Acute Gangrenous Cholecystitis: Proposal of a Score and Comparison with Previous Published Scores. J Gastrointest Surg. 2020; 25(6):1479-1486. DOI: 10.1007/s11605-020-04707-2. View

Maddu K, Phadke S, Hoff C . Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol. 2021; 28(5):1011-1027. DOI: 10.1007/s10140-021-01944-z. View

Shirah B, Shirah H, Saleem M, Chughtai M, Elraghi M, Shams M . Predictive factors for gangrene complication in acute calculous cholecystitis. Ann Hepatobiliary Pancreat Surg. 2019; 23(3):228-233. PMC: 6728255. DOI: 10.14701/ahbps.2019.23.3.228. View

10.

Sureka B, Jha S, Rodha M, Chaudhary R, Elhence P, Khera P . Combined hyperdense gallbladder wall-lumen sign: new computed tomography sign in acute gangrenous cholecystitis. Pol J Radiol. 2020; 85:e183-e187. PMC: 7218447. DOI: 10.5114/pjr.2020.94337. View

11.

Wu C, Lu W, Zhang Y, Zhang G, Shi X, Hisada Y . Inflammasome Activation Triggers Blood Clotting and Host Death through Pyroptosis. Immunity. 2019; 50(6):1401-1411.e4. PMC: 6791531. DOI: 10.1016/j.immuni.2019.04.003. View

12.

Tse J, Gologorsky R, Shen L, Bingham D, Jeffrey R, Kamaya A . Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat. Abdom Radiol (NY). 2022; 47(3):1061-1070. DOI: 10.1007/s00261-021-03320-4. View

13.

Cayrol J, Miguez M, Guerrero G, Tomatis C, Simal I, Maranon R . Diagnostic accuracy and prognostic utility of D Dimer in acute appendicitis in children. Eur J Pediatr. 2015; 175(3):313-20. DOI: 10.1007/s00431-015-2632-3. View

14.

Yacoub W, Petrosyan M, Sehgal I, Ma Y, Chandrasoma P, Mason R . Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score. Gastroenterol Res Pract. 2010; 2010:901739. PMC: 2902011. DOI: 10.1155/2010/901739. View

15.

Borzellino G, Steccanella F, Mantovani W, Genna M . Predictive factors for the diagnosis of severe acute cholecystitis in an emergency setting. Surg Endosc. 2013; 27(9):3388-95. DOI: 10.1007/s00464-013-2921-8. View

16.

MORFIN E, PONKA J, Brush B . Gangrenous cholecystitis. Arch Surg. 1968; 96(4):567-73. DOI: 10.1001/archsurg.1968.01330220083015. View

17.

Portinari M, Scagliarini M, Valpiani G, Bianconcini S, Andreotti D, Stano R . Do I Need to Operate on That in the Middle of the Night? Development of a Nomogram for the Diagnosis of Severe Acute Cholecystitis. J Gastrointest Surg. 2018; 22(6):1016-1025. DOI: 10.1007/s11605-018-3708-y. View

18.

Raffee L, Kuleib S, Oteir A, Kewan T, Alawneh K, Beovich B . Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis. Postgrad Med J. 2019; 96(1133):134-138. DOI: 10.1136/postgradmedj-2019-137095. View

19.

Liu W, Laranjo L, Klimis H, Chiang J, Yue J, Marschner S . Machine-learning versus traditional approaches for atherosclerotic cardiovascular risk prognostication in primary prevention cohorts: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2023; 9(4):310-322. PMC: 10284268. DOI: 10.1093/ehjqcco/qcad017. View

20.

Yavuz E, Eyupoglu C . An effective approach for breast cancer diagnosis based on routine blood analysis features. Med Biol Eng Comput. 2020; 58(7):1583-1601. DOI: 10.1007/s11517-020-02187-9. View