Liver disease in cystic fibrosis.

OBJECTIVES

To develop and validate a machine-learning (ML) model that flags primary Sjögren's disease (pSjD) patients at high risk of depressive symptoms for earlier clinical attention.

METHODS

We retrospectively studied 147 pSjD patients (Nanjing First Hospital, 2019-2022). Depressive symptoms were screened with Patient Health Questionnaire-9 (PHQ-9); PHQ-9 ≥5 was the primary endpoint. Missing data were handled by multiple imputation. Data were split 70/30 for training/testing. After univariate screening and LASSO selection, eight ML algorithms (e.g., logistic regression, support vector machine (SVM), tree/boosting methods) were trained with stratified 10-fold cross-validation. Performance was summarised by AUROC/AUPRC, accuracy, precision/recall, Brier score, and calibration; SHAP provided model explainability.

RESULTS

Four routinely available predictors were retained: fatigue frequency, sleep duration, lymphocyte count, and anti-Ro52 status. Across repeated cross-validation, SVM showed the best overall discrimination (mean AUROC≈0.90) with strong precision and accuracy. In the held-out test set, SVM maintained high performance (AUROC=0.929; AUPRC=0.959; Brier=0.106). SHAP confirmed predictor importance, indicating higher risk with shorter sleep, lower lymphocyte counts, greater fatigue frequency, and anti-Ro52 positivity.

CONCLUSIONS

This study presents the first ML-based model for predicting depressive symptoms in pSjD patients, highlighting the significance of immuno-inflammatory and clinical factors in depression pathogenesis. The SVM model offers a robust, non-invasive tool for early identification of high-risk individuals, enabling timely and personalised interventions. However, this single-centre, retrospective design with a modest sample limits generalisability; therefore, independent multi-centre validation is required before clinical use.