A machine learning-based risk prediction model for Hospitalized patients with deep vein thrombosis

Background Deep vein thrombosis (DVT) is a common thrombotic condition with substantial morbidity when not identified early. Machine learning (ML)–based predictive models may improve early identification of patients at high risk for DVT, but few clinically applicable early-risk models exist. Objectives To develop and internally validate a ML model using routinely available clinical and laboratory indicators for early risk prediction of DVT, and to identify the most influential predictors using model explainability techniques. Methods We retrospectively analyzed clinical data from 231 patients evaluated at the Fifth Affiliated Hospital of Southern Medical University between January 2017 and June 2024. Patients were labeled as DVT occurrence ( n = 159) or non-occurrence ( n = 72). Seven candidate predictors were selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. The dataset was split into training (70%, n = 162) and test (30%, n = 69) sets. Five ML algorithms were trained: XGBoost, CatBoost, Random Forest (RF), Logistic Regression, and Support Vector Machine, with hyperparameter tuning on the training set. Model performance was assessed by 5-fold cross-validation and on the held-out test set using Area Under the Receiver Operating Characteristic Curve (AUC), accuracy, recall, and F1 score. The best model was further interpreted via feature importance and Shapley Additive Explanations (SHAP). Results LASSO selected seven predictors: hemoglobin, platelet count, leukocyte count, fibrinogen, prothrombin time, D-dimer (DD), and glucose. The Random Forest model showed the best discrimination (test-set AUC = 0.874), with favorable accuracy, recall, and F1 compared with other classifiers (detailed metrics reported in the manuscript). In the RF model, D-dimer had the highest feature-importance contribution; SHAP analysis confirmed DD as the dominant risk driver and characterized the directions and relative effects of other features. Conclusions We developed an internally validated ML model for early DVT risk prediction using seven routine clinical variables; Random Forest achieved the best performance and identified D-dimer as the most influential predictor. This model may support earlier identification and intervention for patients at risk of DVT, pending external validation and prospective evaluation.