Figure 1
Flow chart of the study population enrollment. eGFR: estimate glomerular filtration rate.
Table 1
Patients’ baseline clinical characteristics by study group.
| CHARACTERISTICS | WITHOUT DR GROUP (n = 15,444) | WITH DR GROUP (n = 3,383) | p VALUE |
|---|---|---|---|
| Demographic | |||
| Gender(Male),n(%) | 9,389(60.8%) | 1,920(56.8%) | <0.001 |
| Age | 66.84 ± 15.40 | 67.01 ± 16.86 | 0.013 |
| Comorbidities,n(%) | |||
| Hypokalemia | 2,351(15.2%) | 657(19.4%) | <0.001 |
| Hyponatremia | 1,839(11.9%) | 850(25.1%) | <0.001 |
| Tumor | 845(5.5%) | 187(5.5%) | 0.896 |
| Pulmonary infection | 1,486(9.6%) | 631(18.7%) | <0.001 |
| Hyperlipidemia disease | 1,135(7.3%) | 154(4.6%) | <0.001 |
| Hypertension | 3,664(23.7%) | 762(22.5%) | 0.136 |
| T2DM | 4,405(28.5%) | 1,121(33.1%) | <0.001 |
| kidney disease | 1,140(7.4%) | 575(17.0%) | <0.001 |
| Physical | |||
| BMI | 24.34 ± 4.07 | 23.98 ± 4.23 | <0.001 |
| DBP(mmHg) | 74.06 ± 12.76 | 73.27 ± 13.78 | <0.001 |
| SBP(mmHg) | 129.49 ± 20.30 | 127.69 ± 23.05 | <0.001 |
| Laboratory Results | |||
| C-reactive protein assay(mg/dl) | 1.91(0.34–2.72)* | 2.51(0.53–4.0)* | <0.001 |
| Glutamyl transferase(U/L) | 35.6(21.4–62.05)* | 47.7(25.1–87.2)* | <0.001 |
| Neutrophil (%) | 0.67 ± 0.12 | 0.74 ± 0.14 | <0.001 |
| Lactate dehydrogenase(U/L) | 189.5(158.2–247.5)* | 242.5(188.1–327.9)* | <0.001 |
| Carbon dioxide (mmol/L) | 25.89 ± 3.78 | 24.86 ± 4.98 | <0.001 |
| LDL-C(mmol/L) | 2.34 ± 0.79 | 2.27 ± 0.92 | <0.001 |
| IN Ratio | 1.21 ± 0.51 | 1.35 ± 0.75 | <0.001 |
| Aspartate aminotransferase(U/L) | 20.3(15.7–28.9)* | 23.3(16.5–38.3)* | <0.001 |
| Mean RBC volume (fL) | 91.46 ± 6.17 | 91.43 ± 6.91 | 0.72 |
| RBC hemoglobin concen.(g/L) | 332.26 ± 14.42 | 329.83 ± 16.25 | <0.001 |
| TC(mmol/L) | 3.98 ± 1.02 | 3.88 ± 1.21 | <0.001 |
| Total protein(g/L) | 66.63 ± 7.47 | 64.02 ± 9.33 | <0.001 |
| Inorganic phosphorus (mmol/L) | 1.16(0.98–1.27)* | 1.17(0.96–1.35)* | <0.001 |
| Chloride (mmol/L) | 102.97 ± 5.14 | 101.47 ± 6.48 | <0.001 |
| Lymphocyte (%) | 0.24 ± 0.10 | 0.18 ± 0.11 | <0.001 |
| WBC (10e9/L) | 6.6(5.27–8.2)* | 7.46(5.54–10.23)* | <0.001 |
| Direct bilirubin (umol/L) | 4.4(2.9–7.2)* | 5.3(2.9–10.5)* | <0.001 |
| AP (U/L) | 70.3(56.6–84.4)* | 77.4(60.2–100.6)* | <0.001 |
| RDW (%) | 14.14 ± 1.89 | 15.02 ± 2.31 | <0.001 |
| HCT (%) | 0.38 ± 0.07 | 0.35 ± 0.08 | <0.001 |
| RBC (10e12/L) | 4.18 ± 0.77 | 3.81 ± 0.89 | <0.001 |
| Creatinine (umol/L) | 92.31 ± 41.26 | 117.43 ± 59.14 | <0.001 |
| Troponin T (ng/mL) | 0.04(0.02–0.31)* | 0.05(0.02–0.20)* | <0.001 |
| pro-BNP (pg/mL) | 3238(867.2–6726.3)* | 6470(2230–10513)* | <0.001 |
| Glucose (mmol/L) | 6.60 ± 2.92 | 7.62 ± 3.88 | <0.001 |
| PLT (10e9/L) | 193.47 ± 76.81 | 184.17 ± 88.51 | <0.001 |
| D-dimer (μg/mL) | 1.88 ± 2.97 | 3.27 ± 4.21 | <0.001 |
| PT (s) | 15.01 ± 4.03 | 16.27 ± 5.75 | <0.001 |
| PTA (%) | 77.40 ± 16.12 | 71.76 ± 18.51 | <0.001 |
| FIB (mg/dL) | 3.59(2.92–4.65)* | 3.88(2.99–5.09)* | <0.001 |
| Serum albumin (g/L) | 37.57 ± 4.98 | 34.38 ± 5.69 | <0.001 |
| HGB (g/L) | 126.90 ± 23.74 | 114.58 ± 27.19 | <0.001 |
| Serum calcium (mmol/L) | 2.22 ± 0.16 | 2.15 ± 0.20 | <0.001 |
| Serum natrium (mmol/L) | 139.86 ± 4.61 | 138.09 ± 5.76 | <0.001 |
| MCH (pg) | 30.39 ± 2.41 | 30.17 ± 2.70 | <0.001 |
| Thrombin time (s) | 17.11 ± 4.38 | 17.45 ± 4.72 | 0.01 |
| Amylase (U/L) | 72.4(47.2–73.6)* | 54.5(37.4–73.6)* | <0.001 |
| Creatine kinase isoenzymes (ng/mL) | 3.77(1.86–9.23)* | 3.39(1.96–9.23)* | 0.011 |
| eGFR (min * 1.73 m2) | 68.37 ± 31.37 | 57.37 ± 33.95 | <0.001 |
| CRF Staging | |||
| I | 2925(18.9%) | 474(14.0%) | 0.010 |
| II | 5933(38.4%) | 837(24.7%) | <0.001 |
| III | 5469(35.4%) | 1327(39.2%) | 0.013 |
| IV | 1117(7.2%) | 745(22.0%) | <0.001 |
| PCI surgery (YES), n(%) | 2119(13.7%) | 303(9.0%) | <0.001 |
| Death in-hospital (YES), n(%) | 523(3.4%) | 728(21.5%) | <0.001 |
[i] * Presented as median (interquartile range).
Categorical variables are presented as n (%). Continuous variables are presented as mean ± standard deviation. AP, alkaline phosphatase; BMI, body mass index; DBP, diastolic blood pressure; D-dimer, plasma D-dimer assay; eGFR, estimated glomerular filtration rate; FBG, fasting blood glucose; FIB, plasma fibrinogen; HCT, hematocrit; HGB, hemoglobin determination; IN ratio, international normalized ratio; LDL-C, low-density lipoprotein cholesterol; MCH, mean corpuscular hemoglobin;CRF, chronic renal failure; PCI, percutaneous coronary intervention; PLT, platelet count; pro-BNP, pro-brain natriuretic peptide; PT, plasma prothrombin time determination; PTA, plasma prothrombin activity; RBC, red blood cell count; RDW, red blood cell volume distribution width; SBP, systolic blood pressure; TC, total cholesterol; T2MD, type 2 diabetes mellitus; WBC, white blood cell count.
Figure 2
Logistic regression analysis of risk factors for diuretic resistance. OR: odds ratio; CI: confidence interval; Generation: the age division. For continuous variables: eGFR, the ORs means the risk per unit increased.
Figure 3
Comparison of prediction performance of six machine learning classification algorithms. The six algorithms include Gradient Boosting Decision Tree (GBDT), Extreme Gradient Boosting (Xg-boost), Random Forest, Light-GBM, Decision Tree, and Support Vector Machine (SVM). The ROC curve of GBDT is shown by the yellow line, the ROC curve of Xg-boost is shown by the blue line, the ROC curve of Random Forest is shown by the green line, the ROC curve of Light-GBM is shown by the orange line, the ROC curve of Decision Tree is shown by the red line, the ROC curve of SVM is shown by the black line.
Figure 4
The optimal classification model obtains the best cutoff point of risk factors for diuretic resistance. eGFR: estimate glomerular filtration rate; HCT: hematocrit; RDW: blood cell volume distribution width; pro-BNP: pro-brain nitric peptide.
Figure 5
(a): SHAP summary graph and the distribution of SHAP values for each sample. (b): SHAP value contribution graph of each indicator of a single sample. (c): Characteristic SHAP value influence diagram of a single sample. (d): Model prediction diagram and explanation for individual.