Machine learning models of ischemia/hemorrhage in moyamoya disease and analysis of its risk factors

Object: This study aimed to determine the risk factors of ischemic/hemorrhagic stroke in patients suffering moyamoya disease (MMD), as well as to compare the effects of six analysis methods. Methods: In the present retrospective study, the data originated from the database of Jiang Xi Province Medical Big Data Engineering & Technology Research Center. In addition, the information of patients with MMD that were admitted to the second affiliated hospital of Nanchang university from January 1st, 2012 to December 31st, 2019 was acquired. Six different machine learning methods were adopted to build the models, and XGboost, Logistic regression (LR) and Support vector machine (SVM) models were adopted to determine the risk factors of ischemic/hemorrhagic stroke in patients with MMD because of their excellent performance. Next, the effects of the built models were compared and validated in internal and independent external validation sets. The external validation set involving 204 cases from January 1st, 2018 to December 31st, 2019. Result: On the whole, 790 patients with MMD were screened, i.e., 397 patients with cerebral infarction and 393 patients with cerebral hemorrhage. In the internal validation set, XGboost model exhibited significant discrimination (AUC>0.75), with its area under the curve (AUC) reaching 0.874 (95% CI: 0.859, 0.889). Compared with the LR and SVM models, the XGboost model in the internal validation set achieved the improved accuracy by 3.2% and 3.1%, respectively, whereas no significant difference was identified. Conclusion: XGboost model could be more efficient in analyzing the risk factors of ischemic/hemorrhagic stroke in patients with MMD; the risk factors of hemorrhagic stroke in MMD might be closely related to Suzuki stages, presence of an aneurysm, rural residence, hospitalization times and age of onset.