A systematic review of machine learning-based prognostic models for acute pancreatitis: Towards improving methods and reporting quality
PLoS Medicine, vol. 22, pp. e1004432
Abstract
BACKGROUND: An accurate prognostic tool is essential to aid clinical decision-making (e.g., patient triage) and to advance personalized medicine. However, such a prognostic tool is lacking for acute pancreatitis (AP). Increasingly machine learning (ML) techniques are being used to develop high-performing prognostic models in AP. However, methodologic and reporting quality has received little attention. High-quality reporting and study methodology are critical for model validity, reproducibility, and clinical implementation. In collaboration with content experts in ML methodology, we performed a systematic review critically appraising the quality of methodology and reporting of recently published ML AP prognostic models. METHODS/FINDINGS: Using a validated search strategy, we identified ML AP studies from the databases MEDLINE and EMBASE published between January 2021 and December 2023. We also searched pre-print servers medRxiv, bioRxiv, and arXiv for pre-prints registered between January 2021 and December 2023. Eligibility criteria included all retrospective or prospective studies that developed or validated new or existing ML models in patients with AP that predicted an outcome following an episode of AP. Meta-analysis was considered if there was homogeneity in the study design and in the type of outcome predicted. For risk of bias (ROB) assessment, we used the Prediction Model Risk of Bias Assessment Tool. Quality of reporting was assessed using the Transparent Reporting of a Multivariable Prediction Model of Individual Prognosis or Diagnosis-Artificial Intelligence (TRIPOD+AI) statement that defines standards for 27 items that should be reported in publications using ML prognostic models. The search strategy identified 6,480 publications of which 30 met the eligibility criteria. Studies originated from China (22), the United States (4), and other (4). All 30 studies developed a new ML model and none sought to validate an existing ML model, producing a total of 39 new ML models. AP severity (23/39) or mortality (6/39) were the most common outcomes predicted. The mean area under the curve for all models and endpoints was 0.91 (SD 0.08). The ROB was high for at least one domain in all 39 models, particularly for the analysis domain (37/39 models). Steps were not taken to minimize over-optimistic model performance in 27/39 models. Due to heterogeneity in the study design and in how the outcomes were defined and determined, meta-analysis was not performed. Studies reported on only 15/27 items from TRIPOD+AI standards, with only 7/30 justifying sample size and 13/30 assessing data quality. Other reporting deficiencies included omissions regarding human-AI interaction (28/30), handling low-quality or incomplete data in practice (27/30), sharing analytical codes (25/30), study protocols (25/30), and reporting source data (19/30). CONCLUSIONS: There are significant deficiencies in the methodology and reporting of recently published ML based prognostic models in AP patients. These undermine the validity, reproducibility, and implementation of these prognostic models despite their promise of superior predictive accuracy. REGISTRATION: Research Registry (reviewregistry1727).
Authors 33
-
Affiliation as printed
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States of America
-
Affiliation as printed
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
Northeast Ohio Medical University
Affiliation as printed
Northeast Ohio Medical School, Rootstown, Ohio, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
Affiliation as printed
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States of America
-
Affiliation as printed
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States of America
-
Affiliation as printed
Department of Process and Data Science, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
-
Affiliation as printed
Department of Process and Data Science, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
-
Massachusetts Institute of Technology
Affiliation as printed
Department of Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
-
Massachusetts Institute of Technology
Affiliation as printed
Department of Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Bioinformatics, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Bioinformatics, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
Affiliation as printed
Department of Systems Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
-
Affiliation as printed
Department of Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
-
University of Southern California
Affiliation as printed
Department of Gastroenterology, University of Southern California, Los Angeles, California, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
University of Illinois Chicago
Affiliation as printed
Department of Gastroenterology, University of Illinois at Chicago, Chicago, Illinois, United States of America
-
University of Pittsburgh · University of Pittsburgh Medical Center
Affiliation as printed
Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
-
University of Southern California
Affiliation as printed
Department of Emergency Medicine, University of Southern California, Los Angeles, California, United States of America
-
University of Pittsburgh · University of Pittsburgh Medical Center
Affiliation as printed
Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
-
Affiliation as printed
Department of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
Johns Hopkins University · Johns Hopkins Medicine · Johns Hopkins Hospital
Affiliation as printed
Department of Gastroenterology, Johns Hopkins Medical Center, Baltimore, Maryland, United States of America
-
Affiliation as printed
Department of Surgical and Translational Research Centre, University of Auckland, Auckland, New Zealand
-
University of Pennsylvania Health System · University of Pennsylvania
Affiliation as printed
Department of Hospital Medicine and Penn Medicine Center for Evidence-based Practice, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
-
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
-
Beth Israel Deaconess Medical Center · Massachusetts Institute of Technology
Affiliation as printed
Department of Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
Department of Critical Care, Beth Israel Medical Center, Boston, Massachusetts, United States of America
-
Peter Lee corresponding
The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Gastroenterology and Hepatology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
Cited by 23 stored of 23
No patents citing this paper on Lens.org (checked 2026-10-06).