Explainable machine learning model for predicting the outcome of acute ischemic stroke after intravenous thrombolysis
Bibliographic record
Abstract
Introduction: Acute ischemic stroke (AIS) patients often experience poor functional outcomes post-intravenous thrombolysis (IVT). Novel computational methods leveraging machine learning (ML) architectures increasingly support medical decision-making. We aimed to develop and validate a machine learning model to predict 3-month unfavorable functional outcome after IVT in AIS patients. Methods: = 324). The least absolute shrinkage and selection operator (LASSO) regression selected predictors from clinical/neuroimaging/laboratory variables. Eight ML algorithms (including Logistic Regression, Random Forest, Extreme Gradient Boosting, Multilayer Perceptron, Support Vector Machine, Light Gradient Boosting Machine, Decision Tree, and K-Nearest Neighbors) were trained using 10-fold cross-validation and evaluated on test/external sets via the area under the curve (AUC), accuracy, precision, recall and F1-score. Additionally, the SHapley Additive exPlanations (SHAP) interpreted the optimal model. Results: = 282) and 324 patients the external validation cohort. Unfavorable 3-month outcomes (mRS 3-6) occurred in 25.7% and 22.8%, respectively. LASSO regression selected five predictors: the neutrophil-to-lymphocyte ratio (NLR), admission National Institutes of Health Stroke Scale (NIHSS) score, the Alberta Stroke Program Early CT Score (ASPECTS), atrial fibrillation, and blood glucose. While tree-based methods like XGBoost and LightGBM showed elevated training performance (e.g., XGBoost training AUC = 0.878) but significant drops in validation (AUC = 0.791), LR demonstrated optimal performance: robust training AUC (0.792), minimal validation degradation (AUC = 0.787). LR model was subsequently employed as classification method demonstrating optimal performance with (AUC = 0.777) in the test dataset. External validation confirmed LR's stability (AUC = 0.797). SHAP analysis ranked NLR as the strongest predictor (followed by NIHSS/ASPECTS), with higher values increasing risk. Learning curves indicated no overfitting. A nomogram enabled individualized risk quantification. Conclusion: A parsimonious 5-variable LR model robustly predicts 3-month post-IVT outcomes, combining clinical utility, interpretability, and generalizability. NLR-driven inflammation is critical to prognosis. This tool facilitates early high-risk patient identification for personalized intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".