A robust clustering strategy for stratification unveils unique patient subgroups in acutely decompensated cirrhosis

作者：Sara Palomino‐Echeverría, Estefanía Huergo, Asier Ortega‐Legarreta, Eva M. Uson Raposo, Ferrán Aguilar, Carlos de la Peña-Ramirez, Cristina López‐Vicario, Carlo Alessandria, Wim Laleman, Alberto Queiróz Farias, Richard Moreau, Javier Fernández, Vicente Arroyo, Paolo Caraceni, Vincenzo Lagani, Cristina Sánchez-Garrido, Joan Clària, Jesper N. Tegner, Jonel Trebicka, Narsis A. Kiani, Núria Planell, Pierre‐Emmanuel Rautou, David Gómez-Cabrero · 发表于：Journal of Translational Medicine · 年份：2024 · DOI：10.1186/s12967-024-05386-2 · 被引用次数：4 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Hepatitis C virus research

BACKGROUND: Patient heterogeneity poses significant challenges for managing individuals and designing clinical trials, especially in complex diseases. Existing classifications rely on outcome-predicting scores, potentially overlooking crucial elements contributing to heterogeneity without necessarily impacting prognosis. METHODS: To address patient heterogeneity, we developed ClustALL, a computational pipeline that simultaneously faces diverse clinical data challenges like mixed types, missing values, and collinearity. ClustALL enables the unsupervised identification of patient stratifications while filtering for stratifications that are robust against minor variations in the population (population-based) and against limited adjustments in the algorithm's parameters (parameter-based). RESULTS: Applied to a European cohort of patients with acutely decompensated cirrhosis (n = 766), ClustALL identified five robust stratifications, using only data at hospital admission. All stratifications included markers of impaired liver function and number of organ dysfunction or failure, and most included precipitating events. When focusing on one of these stratifications, patients were categorized into three clusters characterized by typical clinical features; notably, the 3-cluster stratification showed a prognostic value. Re-assessment of patient stratification during follow-up delineated patients' outcomes, with further improvement of the prognostic value of the stratification. We valid...