Using Machine Learning to Evaluate the Role of Microinflammation in Cardiovascular Events in Patients With Chronic Kidney Disease

Xiao Qi Liu,Feng Yong Jin,Meng Ying Wang,Qing Zhao,Gui Hua Wang,Yu Lin Huang,Ting Ting Jiang,Yang Huang,Kun Ling Ma,Wen Tao Liu,Bi Cheng Liu,Xiong Zhong Ruan

doi:10.3389/fimmu.2021.796383

Abstract

BackgroundLipid metabolism disorder, as one major complication in patients with chronic kidney disease (CKD), is tied to an increased risk for cardiovascular disease (CVD). Traditional lipid-lowering statins have been found to have limited benefit for the final CVD outcome of CKD patients. Therefore, the purpose of this study was to investigate the effect of microinflammation on CVD in statin-treated CKD patients.MethodsWe retrospectively analysed statin-treated CKD patients from January 2013 to September 2020. Machine learning algorithms were employed to develop models of low-density lipoprotein (LDL) levels and CVD indices. A fivefold cross-validation method was employed against the problem of overfitting. The accuracy and area under the receiver operating characteristic (ROC) curve (AUC) were acquired for evaluation. The Gini impurity index of the predictors for the random forest (RF) model was ranked to perform an analysis of importance.ResultsThe RF algorithm performed best for both the LDL and CVD models, with accuracies of 82.27% and 74.15%, respectively, and is therefore the most suitable method for clinical data processing. The Gini impurity ranking of the LDL model revealed that hypersensitive C-reactive protein (hs-CRP) was highly relevant, whereas statin use and sex had the least important effects on the outcomes of both the LDL and CVD models. hs-CRP was the strongest predictor of CVD events.ConclusionMicroinflammation is closely associated with potential CVD events in CKD patients, suggesting that therapeutic strategies against microinflammation should be implemented to prevent CVD events in CKD patients treated by statin.

Highlights

In the death of patients with chronic kidney disease (CKD), cardiovascular events are the uppermost factors
We found complete data for 914 cases of electronic medical record (EMR), including serum creatinine (Scr), body mass index (BMI), serum alanine transaminase (ALT), serum aspartate transaminase (AST), serum albumin, total cholesterol (TC), blood glucose, haemoglobin, erythrocyte sedimentation rate (ESR), systolic blood pressure, diastolic blood pressure, white blood cells, age, sex, and use of statins
A total of 11932 EMRs were collected, of which 2578 EMRs were diagnosed as CKD with hypersensitive C-reactive protein (hs-CRP) determination reports

Summary

Introduction

In the death of patients with chronic kidney disease (CKD), cardiovascular events are the uppermost factors. Some studies have revealed a U-shaped relationship between the plasma cholesterol level and CVD mortality among patients with end-stage renal disease (ESRD), indicating an increase in mortality related to CVD when the plasma lowdensity lipoprotein (LDL) level declined to normal or below normal [3]. AURORA and 4D clinical trials both demonstrated that statins lowered the plasma LDL cholesterol level of ESRD patients undergoing maintenance dialysis but had no significant effect on CVD events [5, 6]. We previously demonstrated microinflammation-induced cholesterol redistribution from peripheral tissues to the liver and from extracellular to intracellular regions, resulting in hypolipidaemia and accelerating kidney injury, atherosclerosis, and nonalcoholic fatty liver disease [9,10,11,12,13]. The purpose of this study was to investigate the effect of microinflammation on CVD in statin-treated CKD patients

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