The lived experience of functional bowel disorders: a machine learning approach

James K Ruffle, Michelle Henderson, Cho Ee Ng, Trevor Liddle, Amy P. K. Nelson, Parashkev Nachev, Charles H Knowles, Yan Yiannakou
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Abstract

Objective: Functional bowel disorders (FBDs) are multi-dimensional diseases varying in demographics, symptomology, lifestyle, mental health, and susceptibility to treatment. The patient lived experience is an integration of these factors, best understood with appropriately multivariate models. Methods: In a large patient cohort (n=1175), we developed a machine learning framework to better understand the lived experience of FBDs. Iterating through 59 factors available from routine clinical care, spanning patient demography, diagnosis, symptomatology, life-impact, mental health indices, healthcare access requirements, COVID-19 impact, and treatment effectiveness, machine models were used to quantify the predictive fidelity of one feature from the remainder. Bayesian stochastic block models were used to delineate the network community structure underpinning the lived experience of FBDs. Results: Machine models quantified patient personal health rating (R2 0.35), anxiety and depression severity (R2 0.54), employment status (balanced accuracy 96%), frequency of healthcare attendance (R2 0.71), and patient-reported treatment effectiveness variably (R2 range 0.08-0.41). Contrary to the view of many healthcare professionals, the greatest determinants of patient-reported health and quality-of-life were life-impact, mental wellbeing, employment status, and age, rather than diagnostic group and symptom severity. Patients responsive to one treatment were more likely to respond to another, leaving many others refractory to all. Conclusions: The assessment of patients with FBDs should be less concerned with diagnostic classification than with the wider life impact of illness, including mental health and employment. The stratification of treatment response (and resistance) has implications for clinical practice and trial design, in need of further research.
功能性肠病的生活体验:一种机器学习方法
目的:功能性肠病(FBD)是一种多维疾病,在人口统计学、症状学、生活方式、心理健康和对治疗的易感性等方面各不相同。患者的生活经历是这些因素的综合体,最好通过适当的多变量模型来理解:在一个大型患者队列(n=1175)中,我们开发了一个机器学习框架,以更好地了解 FBD 患者的生活经历。通过对患者人口统计学、诊断、症状学、生活影响、心理健康指数、医疗保健访问要求、COVID-19 影响和治疗效果等 59 个常规临床护理因素进行迭代,使用机器模型来量化一个特征与其余特征的预测保真度。贝叶斯随机区块模型被用来描述支持家庭边际障碍患者生活体验的网络社区结构:机器模型对患者个人健康评分(R2 0.35)、焦虑和抑郁严重程度(R2 0.54)、就业状况(平衡准确率 96%)、就医频率(R2 0.71)和患者报告的治疗效果进行了不同程度的量化(R2 范围为 0.08-0.41)。与许多医护人员的观点相反,患者报告的健康和生活质量的最大决定因素是生活影响、精神健康、就业状况和年龄,而不是诊断组别和症状严重程度。对一种治疗方法有反应的患者更有可能对另一种治疗方法有反应,而对所有治疗方法都难治的患者则为数众多:结论:对 FBD 患者进行评估时,应减少对诊断分类的关注,而更多地关注疾病对生活的影响,包括精神健康和就业。治疗反应(和耐药性)的分层对临床实践和试验设计有影响,需要进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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