Development of a deep learning model for guiding treatment decisions of acute variceal bleeding in patients with cirrhosis

Figure 1 Flowchart of study population. AVB: Acute variceal bleeding; AI: Artificial intelligence; EIS: Endoscopic injection sclerotherapy; EVL: Endoscopic variceal ligation; TIPS: Transjugular intrahepatic portosystemic shunt; p-TIPS: Preemptive transjugular intrahepatic portosystemic shunt; PT: Pharmacotherapy.

Figure 2 Workflow of the development and testing of artificial intelligence-acute variceal bleeding model. A: Overview of the prediction pipeline; B: Architecture of artificial intelligence-acute variceal bleeding; C: Architecture of atrous spatial pyramid pooling; D: Architecture of blocks. SBP: Systolic blood pressure; HR: Heart rate; AVB: Acute variceal bleeding; AI: Artificial intelligence; P: Positive; N: Negative; ICU: Intensive care unit; AUC: Area under the curve; RB: Residual block; CB: Convolution block; LB: Linear block; ASPP: Atrous spatial pyramid pooling; ReLU: Rectified linear unit; Conv: Convolution; Norm: Normalization; Drop: Dropout.

Figure 3 Receiver operating characteristic curves and confusion matrix of different models for clinical outcomes in acute variceal bleeding patients. A-C: Receiver operating characteristic curves of seven models for 6-week treatment failure, 1-year mortality, intensive care unit (ICU) requirement, respectively, in the internal and external validation cohort; D-F: Confusion matrix for 6-week treatment failure, 1-year mortality, ICU requirement, respectively, in the internal and external validation cohort using artificial intelligence-acute variceal bleeding algorithms. True labels on the vertical axis and predicted labels on the horizontal axis. ICU: Intensive care unit; AUC: Area under the curve; SVM: Support vector machine; LR: Logistic regression; DT: Decision tree; RF: Random forest; XGB: Extreme gradient boosting; LGBM: Light gradient boosting machine; AVB: Acute variceal bleeding; AI: Artificial intelligence.

Figure 4 Cumulative incidence of treatment outcomes in high or low-risk acute variceal bleeding patients. A: 6-week treatment failure in high or low-risk patients; B and C: 1-year survival rates in high and low risk patients. EVL: Endoscopic variceal ligation; p-TIPS: Preemptive transjugular intrahepatic portosystemic shunt; PT: Pharmacotherapy.