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Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters
PURPOSE: To validate a clinical decision support system (CDSS) that estimates risk of diabetic retinopathy (DR) and to personalize screening protocols in type 2 diabetes mellitus (T2DM) patients. METHODS: We utilized a CDSS based on a fuzzy random forest, integrated by fuzzy decision trees with the...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Association for Research in Vision and Ophthalmology
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980045/ https://www.ncbi.nlm.nih.gov/pubmed/34003951 http://dx.doi.org/10.1167/tvst.10.3.17 |
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author | Romero-Aroca, Pedro Verges-Pujol, Raquel Santos-Blanco, Esther Maarof, Najlaa Valls, Aida Mundet, Xavier Moreno, Antonio Galindo, Luis Baget-Bernaldiz, Marc |
author_facet | Romero-Aroca, Pedro Verges-Pujol, Raquel Santos-Blanco, Esther Maarof, Najlaa Valls, Aida Mundet, Xavier Moreno, Antonio Galindo, Luis Baget-Bernaldiz, Marc |
author_sort | Romero-Aroca, Pedro |
collection | PubMed |
description | PURPOSE: To validate a clinical decision support system (CDSS) that estimates risk of diabetic retinopathy (DR) and to personalize screening protocols in type 2 diabetes mellitus (T2DM) patients. METHODS: We utilized a CDSS based on a fuzzy random forest, integrated by fuzzy decision trees with the following variables: current age, sex, arterial hypertension, diabetes duration and treatment, HbA1c, glomerular filtration rate, microalbuminuria, and body mass index. Validation was made using the electronic health records of a sample of 101,802 T2DM patients. Diagnosis was made by retinal photographs, according to EURODIAB guidelines and the International Diabetic Retinopathy Classification. RESULTS: The prevalence of DR was 19,759 patients (19.98%). Results yielded 16,593 (16.31%) true positives, 72,617 (71.33%) true negatives, 3165 (3.1%) false positives, and 9427 (9.26%) false negatives, with an accuracy of 0.876 (95% confidence interval [CI], 0.858–0.886), sensitivity of 84% (95% CI, 83.46–84.49), specificity of 88.5% (95% CI, 88.29–88.72), positive predictive value of 63.8% (95% CI, 63.18–64.35), negative predictive value of 95.8% (95% CI, 95.68–95.96), positive likelihood ratio of 7.30, and negative likelihood ratio of 0.18. The type 1 error was 0.115, and the type 2 error was 0.16. CONCLUSIONS: We confirmed a good prediction rate for DR from a representative sample of T2DM in our population. Furthermore, the CDSS was able to offer an individualized screening protocol for each patient according to the calculated risk confidence value. TRANSLATIONAL RELEVANCE: Results from this study will help to establish a novel strategy for personalizing screening for DR according to patient risk factors. |
format | Online Article Text |
id | pubmed-7980045 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | The Association for Research in Vision and Ophthalmology |
record_format | MEDLINE/PubMed |
spelling | pubmed-79800452021-03-26 Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters Romero-Aroca, Pedro Verges-Pujol, Raquel Santos-Blanco, Esther Maarof, Najlaa Valls, Aida Mundet, Xavier Moreno, Antonio Galindo, Luis Baget-Bernaldiz, Marc Transl Vis Sci Technol Article PURPOSE: To validate a clinical decision support system (CDSS) that estimates risk of diabetic retinopathy (DR) and to personalize screening protocols in type 2 diabetes mellitus (T2DM) patients. METHODS: We utilized a CDSS based on a fuzzy random forest, integrated by fuzzy decision trees with the following variables: current age, sex, arterial hypertension, diabetes duration and treatment, HbA1c, glomerular filtration rate, microalbuminuria, and body mass index. Validation was made using the electronic health records of a sample of 101,802 T2DM patients. Diagnosis was made by retinal photographs, according to EURODIAB guidelines and the International Diabetic Retinopathy Classification. RESULTS: The prevalence of DR was 19,759 patients (19.98%). Results yielded 16,593 (16.31%) true positives, 72,617 (71.33%) true negatives, 3165 (3.1%) false positives, and 9427 (9.26%) false negatives, with an accuracy of 0.876 (95% confidence interval [CI], 0.858–0.886), sensitivity of 84% (95% CI, 83.46–84.49), specificity of 88.5% (95% CI, 88.29–88.72), positive predictive value of 63.8% (95% CI, 63.18–64.35), negative predictive value of 95.8% (95% CI, 95.68–95.96), positive likelihood ratio of 7.30, and negative likelihood ratio of 0.18. The type 1 error was 0.115, and the type 2 error was 0.16. CONCLUSIONS: We confirmed a good prediction rate for DR from a representative sample of T2DM in our population. Furthermore, the CDSS was able to offer an individualized screening protocol for each patient according to the calculated risk confidence value. TRANSLATIONAL RELEVANCE: Results from this study will help to establish a novel strategy for personalizing screening for DR according to patient risk factors. The Association for Research in Vision and Ophthalmology 2021-03-17 /pmc/articles/PMC7980045/ /pubmed/34003951 http://dx.doi.org/10.1167/tvst.10.3.17 Text en Copyright 2021 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. |
spellingShingle | Article Romero-Aroca, Pedro Verges-Pujol, Raquel Santos-Blanco, Esther Maarof, Najlaa Valls, Aida Mundet, Xavier Moreno, Antonio Galindo, Luis Baget-Bernaldiz, Marc Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters |
title | Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters |
title_full | Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters |
title_fullStr | Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters |
title_full_unstemmed | Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters |
title_short | Validation of a Diagnostic Support System for Diabetic Retinopathy Based on Clinical Parameters |
title_sort | validation of a diagnostic support system for diabetic retinopathy based on clinical parameters |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980045/ https://www.ncbi.nlm.nih.gov/pubmed/34003951 http://dx.doi.org/10.1167/tvst.10.3.17 |
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