AI Model to Predict Gout Recurrence in Hospitalized Patients

Original Title: Development and validation of a multidimensional and interpretable artificial intelligence model to predict gout recurrence in hospitalised patients: a real-world, ambispective multicentre cohort study in China

Journal: BMC medicine

DOI: 10.1186/s12916-025-04454-8

Overview

Researchers addressed the challenge of predicting gout recurrence in hospitalized patients with other health conditions. This large, multicentre study in China included 6,526 patients in both retrospective and prospective cohorts. Using 82 clinical, laboratory, and medication features, the team developed and rigorously tested 3,744 different artificial intelligence models to find the most accurate and reliable one. The final selected model, a Gradient Boosting algorithm, demonstrated good predictive performance. It achieved an area under the curve (AUC) of 0.832 in the training set, 0.785 in the internal validation set, 0.742 in an external validation set, and 0.744 in a prospective validation cohort. An analysis technique called SHAP was used to make the model interpretable, identifying 20 key factors for predicting recurrence, with length of hospital stay being the most influential.

Novelty

This study's contribution lies in its comprehensive and methodologically rigorous approach. It is one of the first to use a large-scale, ambispective (combining retrospective and prospective data) multicentre design to tackle this specific clinical question, enhancing the generalizability of the findings beyond a single institution. The development process was exceptionally thorough, involving the systematic construction and comparative evaluation of 3,744 distinct AI models to ensure the final selection was not arbitrary but based on robust performance across multiple datasets. Furthermore, the model integrates a multidimensional set of 82 objective variables from electronic health records, moving beyond simpler models. By employing SHAP for interpretability, the study provides clinicians with transparent insights into why a prediction is made, a critical feature for clinical adoption.

Potential Clinical / Research Applications

Clinically, the developed model can serve as a practical decision-support tool. It can be implemented upon patient admission to automatically screen and stratify individuals based on their risk of an in-hospital gout flare. For patients identified as high-risk, clinicians could proactively initiate preventive measures, such as prescribing prophylactic anti-inflammatory drugs, optimizing fluid management, and carefully reviewing medication lists to avoid agents known to precipitate gout attacks. The accompanying web-based application facilitates its use in real-time clinical settings.
For research, the 20 predictors identified by the model offer new avenues for investigation into the pathophysiology of acute gout flares in the context of systemic illness. The model itself provides a robust framework that can be tested, validated, and recalibrated for different patient populations and healthcare systems. It could also be used as a risk stratification tool in future clinical trials designed to evaluate the efficacy of novel prophylactic therapies for preventing in-hospital gout recurrence.