{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:06:14Z","timestamp":1790139974818,"version":"4.0.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community-acquired acute cholangitis (CAAC) can progress to acute organ injury (AOI), increasing poor prognosis risk. This study aimed to develop machine learning models using clinical information obtained before AOI onset to predict new-onset AOI within 48\u2005h after admission in patients with CAAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study screened 487 patients with CAAC between January 2018 and December 2022; 456 without AOI at admission were included. The primary outcome was new-onset AOI within 48\u2005h. Candidate predictors included demographic data, medical history, vital signs, laboratory parameters, and composite indices obtained after admission and before AOI onset. Patients were stratified into training and independent test sets at an 8:2 ratio. In the training set, univariable logistic regression (LR) was used for screening, followed by LR with least absolute shrinkage and selection operator (LASSO) penalty via 5-fold cross-validation. Five models were developed: random forest (RF), support vector machine (SVM), LR, neural network (NN), and adaptive boosting (AdaBoost). Optimization used 5-fold stratified cross-validation and grid search. The optimal model was selected by cross-validated area under the receiver operating characteristic curve (ROC-AUC) and evaluated for discrimination, calibration, and net clinical benefit. SHapley Additive exPlanations (SHAP) was used for interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RF and SVM achieved the highest mean cross-validated ROC-AUC (0.847 each). RF was selected per the prespecified tie-breaking protocol. In the independent test set, RF achieved an ROC-AUC of 0.820 [95% confidence interval (CI): 0.720\u20130.906], accuracy of 72.8%, sensitivity of 80.6%, specificity of 68.9%, positive predictive value (PPV) of 56.8%, negative predictive value (NPV) of 87.5%, and F1-score of 0.667. The Brier score was 0.156, calibration intercept 0.014, and calibration slope 1.252. Decision curve analysis (DCA) demonstrated a positive net clinical benefit across threshold probabilities ranging from 0.01 to 0.80. The eight key RF predictors were C-reactive protein (CRP), aspartate aminotransferase-to-platelet ratio index (APRI), MAP, prognostic nutritional index (PNI), gamma-glutamyl transferase-to-albumin ratio (GAR), age, neutrophil-to-lymphocyte ratio (NLR), and drink history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The RF model predicted new-onset AOI within 48\u2005h in patients with CAAC and provided interpretable individual risk information through SHAP analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1882266","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:43:38Z","timestamp":1790138618000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpretable machine learning models for predicting New-onset acute organ injury within 48 hours of admission in patients with community-acquired acute cholangitis"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhi-Xiang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The Affiliated People's Hospital of Jiangsu University","place":["Zhenjiang, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Affiliated People's Hospital of Jiangsu University","place":["Zhenjiang, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang-Pei","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The Affiliated People's Hospital of Jiangsu University","place":["Zhenjiang, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University","place":["Zhenjiang, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)","volume":"25","author":"Kiriyama","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s13054-021-03480-1","article-title":"Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study","volume":"25","author":"Lavillegrand","year":"2021","journal-title":"Crit Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2474","DOI":"10.1007\/s10620-018-4963-1","article-title":"Procalcitonin as a decision-supporting marker of urgent biliary decompression in acute cholangitis","volume":"63","author":"Lee","year":"2018","journal-title":"Dig Dis Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1016\/S1499-3872(12)60240-9","article-title":"Risk factors and incidence of acute pyogenic cholangitis","volume":"11","author":"Qin","year":"2012","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/MEG.0000000000002849","article-title":"Clinical and biochemical factors for bacteria in bile among patients with acute cholangitis","volume":"37","author":"Zhao","year":"2024","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.3748\/wjg.v30.i15.2118","article-title":"Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: a propensity score-matched analysis","volume":"30","author":"Zhou","year":"2024","journal-title":"World J Gastroenterol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1038\/ajg.2011.387","article-title":"The clinical epidemiology and outcomes of bacteremic biliary tract infections caused by antimicrobial-resistant pathogens","volume":"107","author":"Sung","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"156","DOI":"10.5114\/wiitm.2021.108214","article-title":"A randomized controlled trial of emergency LCBDE\u2009+\u2009LC and ERCP\u2009+\u2009LC in the treatment of choledocholithiasis with acute cholangitis","volume":"17","author":"Zou","year":"2021","journal-title":"Wideochir Inne Tech Maloinwazyjne"},{"key":"B9","doi-asserted-by":"publisher","first-page":"300060519866100","DOI":"10.1177\/0300060519866100","article-title":"A nomogram for predicting the risk of sepsis in patients with acute cholangitis","volume":"48","author":"Liu","year":"2019","journal-title":"J Int Med Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1161\/CIRCRESAHA.117.311312","article-title":"Cardiovascular event prediction by machine learning: the multi-ethnic study of atherosclerosis","volume":"121","author":"Ambale-Venkatesh","year":"2017","journal-title":"Circ Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e692","DOI":"10.1016\/S2589-7500(23)00135-8","article-title":"Development and validation of an interpretable machine learning-based calculator for predicting 5-year weight trajectories after bariatric surgery: a multinational retrospective cohort SOPHIA study","volume":"5","author":"Saux","year":"2023","journal-title":"Lancet Digit Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1165510","DOI":"10.3389\/fimmu.2023.1165510","article-title":"Development and validation of a new prognostic immune-inflammatory-nutritional score for predicting outcomes after curative resection for intrahepatic cholangiocarcinoma: a multicenter study","volume":"14","author":"Zhu","year":"2023","journal-title":"Front Immunol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3196","DOI":"10.1111\/jcmm.17321","article-title":"Prognostic significance of gamma-glutamyl transpeptidase to albumin ratio in patients with intrahepatic cholangiocarcinoma after hepatectomy","volume":"26","author":"Li","year":"2022","journal-title":"J Cell Mol Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/kisup.2012.1","article-title":"KDIGO Clinical practice guideline for acute kidney injury","volume":"2","year":"2012","journal-title":"Kidney Int Suppl"},{"key":"B15","doi-asserted-by":"publisher","first-page":"20120614","DOI":"10.1259\/bjr.20120614","article-title":"Acute pulmonary injury: high-resolution CT and histopathological spectrum","volume":"86","author":"Obadina","year":"2013","journal-title":"Br J Radiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/CCM.0000000000002949","article-title":"Delay within the 3-hour surviving sepsis campaign guideline on mortality for patients with severe sepsis and septic shock","volume":"46","author":"Pruinelli","year":"2018","journal-title":"Crit Care Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"547","DOI":"10.17219\/acem\/68363","article-title":"Liver dysfunction in sepsis","volume":"27","author":"Wo\u017anica","year":"2018","journal-title":"Adv Clin Exp Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"l1296","DOI":"10.1136\/bmj.l1296","article-title":"Glasgow Coma scale explained","volume":"365","author":"Mehta","year":"2019","journal-title":"Br Med J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2252","DOI":"10.1093\/eurheartj\/ehs154","article-title":"How to use high-sensitivity cardiac troponins in acute cardiac care","volume":"33","author":"Thygesen","year":"2012","journal-title":"Eur Heart J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"B23","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.molimm.2022.04.003","article-title":"IL-6 regulates induction of C-reactive protein gene expression by activating STAT3 isoforms","volume":"146","author":"Ngwa","year":"2022","journal-title":"Mol Immunol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"255","DOI":"10.3390\/medicina58020255","article-title":"Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute cholangitis","volume":"58","author":"Lee","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e280","DOI":"10.1016\/j.jemermed.2023.05.013","article-title":"The predictive value of different laboratory indicators based on the 2018 Tokyo guidelines for the severity of acute cholangitis","volume":"65","author":"Ye","year":"2023","journal-title":"J Emerg Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"R169","DOI":"10.1186\/cc10313","article-title":"C-reactive protein, an early marker of community-acquired sepsis resolution: a multi-center prospective observational study","volume":"15","author":"P\u00f3voa","year":"2011","journal-title":"Crit Care"},{"key":"B27","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.jcrc.2017.07.001","article-title":"Endothelial glycocalyx biomarkers increase in patients with infection during emergency department treatment","volume":"42","author":"Smart","year":"2017","journal-title":"J Crit Care"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2210","DOI":"10.1007\/s00134-008-1193-6","article-title":"Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24\u2005h in patients with sepsis","volume":"34","author":"Trzeciak","year":"2008","journal-title":"Intensive Care Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1053\/jhep.2003.50346","article-title":"A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C","volume":"38","author":"Wai","year":"2003","journal-title":"Hepatology"},{"key":"B30","doi-asserted-by":"publisher","first-page":"331","DOI":"10.3389\/fped.2019.00331","article-title":"AST-to-Platelet ratio Index as potential early-warning biomarker for sepsis-associated liver injury in children: a database study","volume":"7","author":"Dou","year":"2019","journal-title":"Front Pediatr"},{"key":"B31","doi-asserted-by":"publisher","first-page":"916","DOI":"10.5005\/jp-journals-10071-25079","article-title":"Initial aspartate aminotransferase-to-platelet ratio Index is associated with sepsis-associated liver dysfunction in adult patients with sepsis: a retrospective cohort study","volume":"29","author":"Zhang","year":"2025","journal-title":"Indian J Crit Care Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1097\/SHK.0000000000001015","article-title":"Mechanisms of thrombocytopenia during septic shock: a Multiplex cluster analysis of endogenous sepsis mediators","volume":"49","author":"Bedet","year":"2018","journal-title":"Shock"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3062","DOI":"10.1182\/blood-2015-11-680744","article-title":"Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients","volume":"127","author":"Claushuis","year":"2016","journal-title":"Blood"},{"key":"B34","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1097\/CCM.0000000000003763","article-title":"Association between mean arterial pressure and acute kidney injury and a composite of myocardial injury and mortality in postoperative critically ill patients: a retrospective cohort analysis","volume":"47","author":"Khanna","year":"2019","journal-title":"Crit Care Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1016\/j.chest.2023.07.009","article-title":"Optimizing vasopressin use and initiation timing in septic shock: a narrative review","volume":"164","author":"Sacha","year":"2023","journal-title":"Chest"},{"key":"B36","doi-asserted-by":"publisher","first-page":"2929","DOI":"10.3390\/nu15132929","article-title":"Association of preoperative prognostic nutritional Index with risk of postoperative acute kidney injury: a meta-analysis of observational studies","volume":"15","author":"Liu","year":"2023","journal-title":"Nutrients"},{"key":"B37","doi-asserted-by":"publisher","first-page":"581","DOI":"10.14218\/JCTH.2023.00519","article-title":"Progress in the management of patients with cholestatic liver disease: where are we and where are we going?","volume":"12","author":"Luo","year":"2024","journal-title":"J Clin Transl Hepatol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1016\/j.amjmed.2019.10.031","article-title":"Relationship of nutritional Status, inflammation, and Serum albumin levels during acute illness: a prospective study","volume":"133","author":"Eckart","year":"2019","journal-title":"Am J Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1380750","DOI":"10.3389\/fmed.2024.1380750","article-title":"The predictive value of \u03b3-glutamyl transferase to serum albumin ratio in hepatocellular carcinoma patients after liver transplantation","volume":"11","author":"Luo","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"B40","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.ccc.2020.08.006","article-title":"The effect of aging physiology on critical care","volume":"37","author":"Darden","year":"2020","journal-title":"Crit Care Clin"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1336456","DOI":"10.3389\/fimmu.2024.1336456","article-title":"Predictive value of the neutrophil-to-lymphocyte ratio in the prognosis and risk of death for adult sepsis patients: a meta-analysis","volume":"15","author":"Wu","year":"2024","journal-title":"Front Immunol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"474","DOI":"10.4149\/BLL_2021_078","article-title":"Neutrophil-to-lymphocyte ratio, past, present and future perspectives","volume":"122","author":"Zahorec","year":"2021","journal-title":"Bratisl Lek Listy"},{"key":"B43","doi-asserted-by":"publisher","first-page":"2450","DOI":"10.1016\/j.immuni.2021.10.012","article-title":"The immunology of sepsis","volume":"54","author":"Van Der Poll","year":"2021","journal-title":"Immunity"},{"key":"B44","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1111\/acer.14979","article-title":"A critical review of recent knowledge of alcohol's Effects on the immunological response in different tissues","volume":"47","author":"Crotty","year":"2022","journal-title":"Alcohol Clin Exp Res (Hoboken)"},{"key":"B45","doi-asserted-by":"publisher","first-page":"840752","DOI":"10.3389\/fmed.2022.840752","article-title":"The role of gut Bacteria and fungi in alcohol-associated liver disease","volume":"9","author":"Chen","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1782157","DOI":"10.1080\/19490976.2020.1782157","article-title":"Intestinal permeability, microbial translocation, changes in duodenal and fecal microbiota, and their associations with alcoholic liver disease progression in humans","volume":"12","author":"Maccioni","year":"2020","journal-title":"Gut Microbes"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1882266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:43:46Z","timestamp":1790138626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1882266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":46,"alternative-id":["10.3389\/fmed.2026.1882266"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1882266","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"1882266"}}