Abstract
BACKGROUND: Gout is a chronic inflammatory condition increasingly recognized as a risk factor for cardiovascular events (CVE). Early identification of high-risk individuals is crucial for targeted prevention and management. However, conventional risk stratification approaches often fall short in accuracy and clinical utility. This study aimed to develop and validate a robust, interpretable machine learning (ML)-based model for predicting CVE in patients with gout. METHODS: This retrospective cohort study included 686 hospitalized gout patients at Xiyuan Hospital (Beijing, China) between January 1, 2013, and December 31, 2023. We applied Synthetic Minority Oversampling Technique (SMOTE) combined with random undersampling of the majority class. Then, patients were randomly divided into training (70%) and testing (30%) sets. A comprehensive set of clinical and biochemical variables (n = 39) was collected. Feature selection was performed using Boruta algorithms and Lasso to identify the most predictive variables. Multiple ML algorithms-including Decision Tree Learner, LightGBM Learner, K Nearest Neighbors Learner, CatBoost Learner, Gradient Boosting Desicion Tree Learner-were implemented to construct predictive models. SHAP values were used to assess model interpretability, and robustness was evaluated through 10-fold bootstrap resampling with enhanced standard error estimation. RESULTS: Of the 686 patients, 263 experienced cardiovascular events during follow-up (incidence rate: 38.3%). A logistic regression model was constructed based on eight variables selected using the Boruta feature selection algorithm: sex, age, PLT, EOS, LYM, CO2, GLU and APO-B. Among the five models evaluated, the CatBoost classifier achieved the best performance, with the highest area under the ROC curve (AUC) of 0.976 and the recall of 0.971. Furthermore, SHAP (SHapley Additive exPlanations) values were employed to provide both global and individual-level interpretability of the CatBoost model. To assess the model's generalization performance, bootstrap resampling was performed 10 times. Based on these results, the standard error was improved using machine learning-based enhancement methods, thereby optimizing the model's robustness and predictive stability. CONCLUSION: The logistic regression analysis revealed that age (OR=1.351, p<0.001), CO2 (OR=0.603, p=0.004), eosinophil count (OR=2.128, p=0.001), and platelet count (OR=0.961, p<0.001) were significantly associated with the outcome, indicating their potential roles as independent predictors. Notably, while APO_B (p=0.138) and sex (p=0.132) showed no significant association, glucose levels (OR=2.1, p=0.066) exhibited a marginal trend toward significance, warranting further investigation. This tool may support clinicians in identifying high-risk individuals, enabling early interventions and optimized management strategies. LIMITATIONS: This study has several limitations. First, the analysis was based on a single-center dataset, which may limit the generalizability of the findings. External validation in multi-center and prospective cohorts, along with an expanded sample size, is warranted to confirm these results. Second, key confounding factors such as medication use, lifestyle habits, and gout flare frequency were not included in the analysis; future studies should incorporate these variables to provide a more comprehensive assessment.