Interpretable Machine Learning Approaches for Identification Acute Aortic Dissection in Chest Pain Patients.

Background: The aim of this study is using interpretable machine learning methods to construct models by combing routine laboratory examination biomarkers and clinical characteristics to identify acute aortic dissection (AAD) patients from other sudden chest pain patients referring to acute myocardial infarction (AMI), acute pulmonary embolism (APE) and abdominal aortic aneurysm (AAA).

Methods: The research encompassed a cohort of 832 individuals, with 515 of them diagnosed as acute aortic dissection patients. Patients were randomly assigned to training and test groups for model development and evaluation, with data collected from medical records and validated by study physicians. LASSO regression was used for variable selection in the study, which utilized nine machine learning algorithms for model development. The DeLong test compared AUC values among models. Optimal parameters were found through grid search on the training set with 5-fold cross validation. The SHAP method ranks input feature importance and explains model outcomes to address model opacity.

Results: Utilizing the LASSO regression technique, eight variables were pinpointed for their nonlinear significance. Evaluation of these models using test set data yielded area under the curve (AUC) values between 0.72 and 0.77, suggesting promising utility in differential diagnosis. The Random Forest method demonstrated noteworthy sensitivity, specificity, and F1 Score. The internal validation set consistently yielded results with an area under the curve (AUC) ranging from 0.71 to 0.77. The SHAP method was utilized to assess the influence of features on the model, identifying N.L and age as the most significant variables.

Conclusion: In this prognostic study, a machine learning model was created to assist in differentiating patients with aortic dissection from those presenting with chest pain. The use of interpretable machine learning techniques allows for the prioritization of key features, showcasing significant potential for application in supporting the prompt diagnosis and treatment of aortic dissection differentials.