Yonsei Med J.  2023 Jan;64(1):25-34. 10.3349/ymj.2022.0381.

Machine-Learning Model for the Prediction of Hypoxaemia during Endoscopic Retrograde Cholangiopancreatography under Monitored Anaesthesia Care

• Kang H
• Lee B
• Jo JH
• Lee HS
• Park JY
• Bang S
• Park SW
• Song SY
• Park J
• Shim H
• Lee JH
• Yang E
• Kim EH
• Kim KJ
• Kim MS
• Chung MJ

• KMID: 2537191
• DOI: http://doi.org/10.3349/ymj.2022.0381

Abstract

Purpose
Hypoxaemia is a significant adverse event during endoscopic retrograde cholangiopancreatography (ERCP) under monitored anaesthesia care (MAC); however, no model has been developed to predict hypoxaemia. We aimed to develop and compare logistic regression (LR) and machine learning (ML) models to predict hypoxaemia during ERCP under MAC.
Materials and Methods
We collected patient data from our institutional ERCP database. The study population was randomly divided into training and test sets (7:3). Models were fit to training data and evaluated on unseen test data. The training set was further split into k-fold (k=5) for tuning hyperparameters, such as feature selection and early stopping. Models were trained over k loops; the i-th fold was set aside as a validation set in the i-th loop. Model performance was measured using area under the curve (AUC).
Results
We identified 6114 cases of ERCP under MAC, with a total hypoxaemia rate of 5.9%. The LR model was established by combining eight variables and had a test AUC of 0.693. The ML and LR models were evaluated on 30 independent data splits. The average test AUC for LR was 0.7230, which improved to 0.7336 by adding eight more variables with an l 1 regularisation-based selection technique and ensembling the LRs and gradient boosting algorithm (GBM). The high-risk group was discriminated using the GBM ensemble model, with a sensitivity and specificity of 63.6% and 72.2%, respectively.
Conclusion
We established GBM ensemble model and LR model for risk prediction, which demonstrated good potential for preventing hypoxaemia during ERCP under MAC.

Keyword

Cholangiopancreatography; endoscopic retrograde; hypoxaemia; machine learning; monitored anaesthesia care; prediction model