用患者自报和尿液指标,机器学习预测衣原体感染风险。
Machine Learning-Based Pre-Test Risk Stratification for PCR-Confirmed Chlamydia Using Patient-Reported Data and Urine Biomarkers

- 结合患者自述症状与尿液检测结果,训练分类模型。
- 组合特征组最高AUC达0.72,性能更稳定。
- 适合资源有限或居家筛查场景优化检测优先级。
早期识别衣原体感染高风险个体有助于在资源受限条件下优化分子检测使用。本研究评估了基于机器学习的预测试风险分层(PTRS)可行性,模型使用常规可得的非侵入性临床数据进行训练。分析了93份经PCR确诊的尿样,包含三类特征:患者自述病史与症状、标准尿检中的尿液生物标志物,以及两者的组合。采用五折分层交叉验证与留出概率估计,评估了五种监督分类器的表现,以受试者工作特征曲线下面积(AUC)及阈值相关指标为评估标准,并通过自助法计算置信区间量化不确定性。仅使用患者自报数据的模型表现中等(最高AUC 0.72);基于尿液生物标志物的模型虽峰值略低但表现更一致,集成方法效果最佳。特征组合小幅提升峰值AUC,降低模型间性能差异,表明鲁棒性增强。结果表明,尿液生物标志物提供了可靠的预测信号,与患者自述信息互补,特征融合进一步提升稳定性。该研究支持将非侵入性常规信息整合至筛查流程,适用于去中心化或居家PCR检测环境,以优化检测优先级。
原文摘要 · Abstract (English)
Early identification of individuals at elevated risk of Chlamydia trachomatis infection may enable optimal use of molecular testing in resource-aware screening. We evaluate the feasibility of pre-test risk stratification (PTRS) using machine-learning models trained on routinely available, non-invasive clinical data. A curated dataset of 93 urine samples with PCR reference labels was analyzed using three feature groups: patient-reported history and symptoms, urine biomarkers from standard urinalysis, and their combination. Five supervised classifiers were evaluated using stratified 5-fold cross-validation with out-of-fold probability estimates. Performance was assessed using area under the receiver operating characteristic curve (AUC) and threshold-dependent metrics, with uncertainty quantified via bootstrap confidence intervals. Models using only patient-reported data showed moderate discrimination (AUC up to 0.72). Urine biomarker-based models demonstrated slightly lower peak discrimination but more consistent performance, with ensemble methods yielding the strongest results. Combining feature groups marginally increased the peak AUC and reduced performance variability across models, indicating improved robustness. Findings indicate that urine biomarkers provide a reliable predictive signal for PTRS that is complementary to patient-reported information, while feature integration enhances robustness. This work supports the integration of non-invasive, routinely available information for PTRS into screening workflows, including decentralized or home-based PCR contexts, to optimize testing prioritization.
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