Utility of support vector machine and decision tree to identify the prognosis of metformin poisoning in the United States: analysis of National Poisoning Data System

BACKGROUND: With diabetes incidence growing globally and metformin still being the first-line for its treatment, metformin’s toxicity and overdose have been increasing. Hence, its mortality rate is increasing. For the first time, we aimed to study the efficacy of machine learning algorithms in predicting the outcome of metformin poisoning using two well-known classification methods, including support vector machine (SVM) and decision tree (DT). METHODS: This study is a retrospective cohort study of National Poison Data System (NPDS) data, the largest data repository of poisoning cases in the United States. The SVM and DT algorithms were developed using training and test datasets. We also used precision-recall and ROC curves and Area Under the Curve value (AUC) for model evaluation. RESULTS: Our model showed that acidosis, hypoglycemia, electrolyte abnormality, hypotension, elevated anion gap, elevated creatinine, tachycardia, and renal failure are the most important determinants in terms of outcome prediction of metformin poisoning. The average negative predictive value for the decision tree and SVM models was 92.30 and 93.30. The AUC of the ROC curve of the decision tree for major, minor, and moderate outcomes was 0.92, 0.92, and 0.89, respectively. While this figure of SVM model for major, minor, and moderate outcomes was 0.98, 0.90, and 0.82, respectively. CONCLUSIONS: In order to predict the prognosis of metformin poisoning, machine learning algorithms might help clinicians in the management and follow-up of metformin poisoning cases.