Explainable machine learning model for predicting decline in platelet count after interventional closure in children with patent ductus arteriosus.

Background: This study aimed to apply four machine learning algorithms to develop the optimal model to predict decline in platelet count (DPC) after interventional closure in children with patent ductus arteriosus (PDA). Methods: Data from children with PDA who underwent successful transcatheter closure at the Second Affiliated Hospital of Wenzhou Medical University and Yuying Children's Hospital from January 2016, to December 2022, were collected. The cohort data were split into training and testing sets. DPC following the intervention is defined as a percentage DPC ≥25% [(baseline platelet count-nadir platelet count)/baseline platelet count]. The extra tree algorithm was used for feature selection and four ML algorithms [random forest (RF), adaptive boosting, extreme gradient boosting, and logistic regression] were established. Moreover, SHapley Additive exPlanation (SHAP) to explain the importance of features and the ML models. Results: This study included 330 children who underwent successful transcatheter closure of PDA, of which 113 (34.2%) experienced DPC. After 62 clinical features were considered, the extra tree algorithm selected six clinical features to build the ML models. Amongst the four ML algorithms, the RF model achieved the greatest AUC. SHAP analysis revealed that pulmonary artery systolic pressure, size of defect and weight were the top three most important clinical features in the RF model. Furthermore, clinical descriptions of two children with PDA, with accurate predictions, and explanations of the prediction results were provided. Conclusion: In this study, an ML model (RF) capable of predicting post-intervention DPC in children with PDA undergoing transcatheter closure was established.