BACKGROUND

Aplastic anemia (AA) and myelodysplastic neoplasms (MDS) have similar peripheral blood manifestations and are clinically characterized by reduced hematological triad. It is challenging to distinguish and diagnose these two diseases. Hence, utilizing machine learning methods, we employed and validated an algorithm that used cell population data (CPD) parameters to diagnose AA and MDS.

METHODS

In this study, CPD parameters were obtained from the Beckman Coulter DxH800 analyzer for 160 individuals diagnosed with AA or MDS through a comprehensive retrospective analysis. The individuals were unselectively assigned to a training cohort (77%) and a testing cohort (23%). Additionally, an external validation cohort consisting of eighty-six elderly patients with AA and MDS from two additional centers was established. The discriminative parameters were carefully analyzed through univariate analysis, and the most predictive variables were selected using least absolute shrinkage and selection operator (LASSO) regression. Six machine learning algorithms were utilized to compare the performance of forecasting AA and MDS patients. The area under the curves (AUCs), calibration curves, decision curves analysis (DCA), and shapley additive explanations (SHAP) plots were employed to interpret and assess the model's predictive accuracy, clinical utility, and stability.

RESULTS

After the comparative evaluation of various models, the logistic regression model emerged as the most suitable machine learning model for predicting the probability of AA and MDS, which utilized five principal variables (age, MNVLY, SDVLY, MNLALSEGC, and MNCEGC) to accurately estimate the risk of these diseases. The best model delivered an AUC of 0.791 in the testing cohort and had a high specificity (0.850) and positive predictive value (0.818). Furthermore, the calibration curve indicated excellent agreement between actual and predicted probabilities. The DCA curve further supported the clinical utility of our model and offered significant clinical advantages in guiding treatment decisions. Moreover, the model's performance was consistent in an external validation group, with an AUC of 0.719.

CONCLUSIONS

We developed a novel model that effectively distinguished elderly patients with AA and MDS, which had the potential to provide physicians assistance in early diagnosis and the proper treatment for the elderly.