ABPA, Acute Exacerbation, Allergic Bronchopulmonary Aspergillosis, Allergic Bronchopulmonary Aspergillosis (ABPA), Machine Learning
Conditions
Keywords
ABPA, Acute exacerbation, Machine Learning
Brief summary
This multicenter bidirectional cohort study aims to develop and externally validate a machine learning model for predicting the risk of acute exacerbation within 1 year in patients with allergic bronchopulmonary aspergillosis (ABPA) during the stable phase, and further to evaluate the model's practical value in risk stratification and clinical decision-making. All patients diagnosed with ABPA according to the ISHAM 2024 criteria will be assigned to either the acute exacerbation group or the non-exacerbation group based on whether they experience an acute exacerbation within 1 year. Enrolled participants will be randomly divided into a training set and an internal validation set. During the feature selection phase, univariate analysis, collinearity diagnostics, feature importance ranking derived from nine machine learning algorithms, and expert consensus are comprehensively applied, ultimately leading to the development of 12 independent machine learning models. Model performance is assessed using the receiver operating characteristic (ROC) curve and its area under the curve (AUC), sensitivity, specificity, F1-score, calibration curve, and decision curve analysis. In addition, external validation further enhances the credibility of the model. To improve clinical interpretability, the SHAP method is employed to quantify the contribution of each feature, and an interactive nomogram is constructed to facilitate clinical application. All participants will be followed up for 12 months, during which regular clinical and laboratory evaluations will be performed.
Interventions
None listed
Sponsors
Qianfoshan Hospital
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Aged between 18 and 80 years old. 2. Consistent with the diagnostic consensus criteria for ABPA proposed by the ISHAM-ABPA Working Group. 3. Patients in stable phase of ABPA: newly diagnosed treatment-naive patients or those with prior ABPA exacerbation who achieved at least 50% improvement in symptoms assessed by Likert scale or visual analogue scale (VAS) following initial therapy, accompanied by marked radiological improvement (≥50% reduction in pulmonary opacities) or a minimum 20% decline in serum total IgE level.
Exclusion criteria
1. Concurrent malignant tumors or severe organ dysfunction involving the heart, brain, kidney and other vital organs. 2. Complicated with severe underlying diseases, including active pulmonary tuberculosis, lung cancer, chronic heart failure (NYHA class Ⅳ), chronic kidney disease stage 5 (CKD 5), decompensated liver cirrhosis, etc. 3. Immunocompromised status, such as human immunodeficiency virus (HIV) infection, long-term oral administration of glucocorticoids or immunosuppressive agents. 4. Pregnant or breastfeeding women. 5. Patients with missing core clinical data or incomplete medical records.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The occurrence of ABPA exacerbation within one year of enrollment. | 1 year | An ABPA exacerbation was defined based on the official ISHAM 2024 criteria: patients with established ABPA presenting with sustained clinical worsening for over 14 days or radiological deterioration, accompanied by a ≥50% elevation in serum total IgE compared to the stable baseline level, after ruling out alternative causes of disease flare. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first acute exacerbation | 1 year | The time from enrollment to the first ABPA exacerbation was recorded. An ABPA exacerbation was defined per the official 2024 ISHAM criteria: patients with established ABPA exhibiting sustained clinical worsening lasting \>14 days or radiological deterioration, alongside a ≥50% rise in serum total IgE from their stable baseline, with other causes of clinical deterioration excluded. |
| Total serum IgE | 1 year | Total serum IgE |
| FEV1 (% predicted) | 1 year | FEV1 (% predicted) |
| Changes in chest CT features including scores for bronchiectasis severity | 1 year | Changes in chest CT features including scores for bronchiectasis severity |
| Aspergillus-specific IgE | 1 year | Aspergillus-specific IgE |
| Aspergillus-specific IgG | 1 year | Aspergillus-specific IgG |
| forced vital capacity (FVC) | 1 year | forced vital capacity (FVC) |
| FEV1/FVC ratio | 1 year | FEV1/FVC ratio |
| diffusing capacity for carbon monoxide (DLCO) | 1 year | diffusing capacity for carbon monoxide (DLCO) |
| extent of bronchiectasis of chest CT | 1 year | extent of bronchiectasis of chest CT |
| mucus plugging on chest CT | 1 year | mucus plugging on chest CT |
| high-attenuation (HAM) on chest CT | 1 year | high-attenuation (HAM) on chest CT |
Countries
China
Contacts
CONTACTQian Qi
Outcome results
None listed