Diagnosis of urinary tract infection based on artificial intelligence methods

https://doi.org/10.1016/j.cmpb.2018.10.007Get rights and content

Highlights

  • UTI is a common disease and its diagnosis is not easy with routine examination procedures.

  • It is aimed at developing a model that diagnoses cystitis and nonspecific urethritis diseases with similar symptoms from urinary tract infections.

  • Comparison of 3 different artificial intelligence methods was presented.

  • This study was able to diagnose UTI with 98.3% accuracy using just two symptoms and one laboratory finding.

Abstract

Background and Objective

Urinary tract infection (UTI) is a common disease affecting the vast majority of people. UTI involves a simple infection caused by urinary tract inflammation as well as a complicated infection that may be caused by an inflammation of other urinary tract organs. Since all of these infections have similar symptoms, it is difficult to identify the cause of primary infection. Therefore, it is not easy to diagnose a UTI with routine examination procedures. Invasive methods that require surgery could be necessary. This study aims to develop an artificial intelligence model to support the diagnosis of UTI with complex symptoms.

Methods

Firstly, routine examination data and definitive diagnosis results for 59 UTI patients gathered and composed as a UTI dataset. Three classification models namely; decision tree (DT), support vector machine (SVM), random forest (RF) and artificial neural network (ANN), which are widely used in medical diagnosis systems, were created to model the definitive diagnosis results using the composed UTI dataset. Accuracy, specificity and sensitivity statistical measurements were used to determine the performance of created models.

Results

DT, SVM, RF and ANN models have 93.22%, 96.61%, 96.61%, 98.30% accuracy, 95.55%, 97.77%, 95.55%, 97.77% sensitivity and 85.71%, 92.85%, 100%, 100% specificy results, respectively.

Conclusions

ANN has the highest accuracy result of 98.3% for UTI diagnosis within the proposed models. Although several symptoms, laboratory findings, and ultrasound results are needed for clinical UTI diagnosis, this ANN model only needs pollacuria, suprapubic pain symptoms and erythrocyte to get the same diagnosis with such accuracy. This proposed model is a successful medical decision support system for UTI with complex symptoms. Usage of this artificial intelligence method has its advantages of lower diagnosis cost, lower diagnosis time and there is no need for invasive methods.

Introduction

Urinary tract infection (UTI) is a common disease (approximately 95% of the total urinary tract infections) generally caused by E. coli bacteria reaching the bladder from the urinary tract and affecting at least half of the people throughout their lives [1], [2]. It may be observed as a simple inflammation of the bladder or a more severe inflammation of other urinary system organs. Inflammations involving only bladders that are not based on another underlying disease are called “simple infections” (cystitis) and all other urinary tract infections are called “complicated infections”. Cystitis is a bladder inflammation. This term is used as a pathological, bacteriological and cystoscopy term. Suddenly starting dysuria, pollacuria, urinary urgency and suprapubic pain are the syndromes of cystitis [3]. Cystitis is diagnosed with pollacuria, suprapubic pain, and burning sensation during urination, if the infection is detected only in the bladder. If the infection has retained the ureter, it is diagnosed as a nonspecific urethritis with diuresis, pollacuria, leukocyte urine findings. This diagnosis is also complicated since the symptoms are intertwined with one of the symptoms. The infection results in septicemia, death or at least the chronicity of the disease, if the organ in which the urinary tract infection is located is not treated properly. Under the top name of UTI, exist all kinds of inflammation on kidney, bladder, and urethra [1], [2].

150 million patients are reported to be diagnosed with UTI per year and $16 billion was spent on these patients [4]. In addition, the lifetime incidence of UTI counts 14,000 from 100,000 men [5]. In women, the three entities, the anus, the vagina mouth and the urethra, are very close to one another. In women, the three entities, the anus, the vagina mouth and the urethra, are very close to one another. Anal and vaginal area bacteria can easily become cystitis caused by passing from the urethra to the bladder. This rate is even higher due to the women urethral anatomy [6].

Routine urinalysis and urine cultures are utilized for the diagnosis of UTI. However, it is not easy to identify the source of the infection and the organ is infected. Depending on the characteristics of patients, it may be required to apply invasive methods such as urineletting separately from the bladder and kidney by placing a catheter in the ureters with the help of the cystoscopy. These invasive methods may cause more complications for the patient. For this reason, developing an AI model based on symptom and laboratory findings will protect the patient from possible complications.

UTI causes 20–30% of all systemic infections. In order to start treatment of the patient, a definite diagnosis is required whether cystitis or nonspecific urethritis is present. Since cystitis and nonspecific urethritis need to be treated with different drugs.

During the diagnosis, cystitis is suspected primarily because the main organ of the lower urinary tract is the bladder. The main symptoms of the acute cystitis are diarrhea, pollacuria, hematuria, leucocyturia, urinary urgency. Sometimes fever rarely participates in this history of acute urinary tract infections in children [7]. It is also accompanied by suprapubic pain. However, fever may also be observed in infections involving the bladder muscle (detrusor). Diabetes and recurrent UTI are also a risk factor for cystitis.

Patients with urethritis are applying to polyclinic with the symptoms of defluxion in urethra and dysuria. Among the urethritis agents, neisseria gonorrhoeae, chlamydia trachomatis, ureaplasma urealyticum and trichomonas vaginalis are the most common factors. However, except for gonorrhea infections, it is difficult to detect other factors in the laboratory environment [8]. In the clinic, it is both impractical and difficult to get results from the urethral drenage culture to diagnose the infections separately except for gonorrhea infections.

Artificial intelligence methods are successfully applied to situations like these where complexity exists. With the use of artificial intelligence in medicine, artificial intelligence programs can be created that can perform clinical diagnostic procedures and recommend treatment suggestions. There are a lot of successful applications of artificial intelligence in the field of medicine, such as classification and diagnosis of diseases, treatment recommendation, drug dosage determination, and so on [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. These applications use artificial intelligence methods such as SVM, ANN, DT, KNN and RF. These artificial intelligence methods are powerful tools that physicians can use to analyze, model, and understand complex clinical data in a variety of medical practice areas.

Furthermore, the use of AI methods in medical practice has become widely accepted. These methods include advantages such as (a) economically and non-linear modeling of large data sets and ease of optimization; (b) the predictive accuracy that has a potential to support clinical decision process; (c) providing an explanation using rule inference or sensitivity analysis which ease to disseminate the information [19].

With artificial intelligence methods, inputs that are independent variables of the system can form complex, nonlinear models by associating them with dependent predicted variable outputs. Artificial intelligence is the most important tool for modeling and decision making. Thus, in this study, various AI classification methods have been compared for diagnose supporting whether UTI with complicated symptoms is cystitis or nonspecific urethritis. Four different AI methods, DT, SVM, RF and ANN, which are frequently used in medical classification problems, have been used in this study [20], [21], [22], [23]. A comparative study of those will give us insight into the merits of the different AI methods when used on this problem.

Section snippets

Data set

In this study, the data set were used of the 59 patients 7–77 years old, 35 female and 24 male, who applied to the Necmettin Erbakan University Meram Medical Faculty Urology Polyclinic between the dates of 2016–2017. These patients were diagnosed and localized as urinary tract infection (cystitis) and nonspecific urethritis. All of these patients were diagnosed with the procedures such as anamnesis, clinical examination, urinalysis, and ultrasonography. A definitive diagnosis chart of the data

Preprocessing

The “normalization” of the data is important in terms of not corrupting the relationship between the variables, the accuracy of the analysis and the network performance. Normalization is a scaling process for each data in the dataset between the upper and lower bounds of the activation function used. The activation function used in the analysis is "sigmoid" function, during the implementation the data were normalized to the range of [0,1] by using the Eq. (9).xi=xixminxmaxxmin

Furthermore,

Results

In this study, it is aimed to develop a model that predicts cystitis and nonspecific urethritis diseases with similar symptoms from urinary tract infections. For this purpose, anamnesis, full urine and ultrasonic examinations of 59 patients who applied to the Urology Clinic for the Meram Medical Faculty Hospital were collected and a UTI dataset was created. Four different artificial intelligence methods, namely DT, SVM, RF and ANN, which are frequently utilized in medical diagnosis systems were

Discussion

From a medical point of view, it is necessary to utilize a large number of symptom and laboratory findings in order to be able to diagnose UTI in the clinic. Even in some cases, subpubic ponction and urinary catheterization of both kidneys are used for localization. The two methods mentioned above are an invasive and complicated procedure. Especially, pollacuria and suprapubic symptoms are the most important indicators of cystitis. From this point of view, the results obtained from the DT

Conflict of interest

The authors of this manuscript declare that they have no financial and personal relationships with other people or organizations that could inappropriately influence their work.

Acknowledgments

The authors would like to thank Necmettin Erbakan University Meram Medical Faculty Urology Polyclinic for its contributions to the study. The authors also would like to thank the reviewers and the editors for their valuable comments and contributions that helped to increase the readability and organization of the present paper significantly.

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