Table 1.

Overview of the main ML applications in urinalysis included in this review.

ReferenceFormatPatient populationPurposeData set (train/test split)Used featuresBest modelResult (cross)-validation setResult test set
Jang et al., 2023 (5)Multicenter, retrospectiveHeterogenous inpatient population (university hospital and diabetes center) for development; outpatients for external validationPredict impaired eGFR using ML models comprising urine test strip parameters, age, and gender357.434 patients (198.015/22.003/74.380/62.945; training/internal validation/external validation 1/external validation 2)Age, gender, 5 urine test strip parameters (protein, blood, glucose, pH, specific gravity)XGBoosteGFR <60 mL/min/1.73 m2:
AUC of 0.91 (95%CI: 0.91–0.92);
eGFR <45 mL/min/1.73 m2:
AUC of 0.94 (95%CI: 0.94–0.95)
Test set 1:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.91 (95%CI: 0.90–0.92);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.95 (95%CI: 0.93–0.96)
Test set 2:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.92 (95%CI: 0.91–0.93);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.94 (95%CI: 0.93–0.96)
Taylor et al., 2018 (49)Single center, retrospectiveEmergency departmentIdentifying the AI algorithm that has the highest diagnostic performance for UTI diagnosis using clinical symptoms and urine particle analysis results80.387 patients (64.310/16.077)Age, gender, WBC, nitrates, leukocytes, bacteria, blood, epithelial cells, history of previous UTI, dysuriaXGBoostAUC: 0.904 (95%CI: 0.898–0.910)
Sensitivity: 61.7% (95%CI: 60.0–63.3%)
Specificity: 94.9%
(95%CI: 94.5–95.3%)
AUC: 0.858 (95%CI: 0.853–0.863)
Sensitivity: 73.8% (95%CI: 72.3–75.2%)
Specificity: 89.2% (95%CI: 88.6–89.8%)
Burton RJ et al., 2019 (50)Single center, RetrospectiveHeterogenous hospital populationUsing AI to reduce the number of urinary cultures without compromising the detection of UTI212.554 urine reports (157.645/67.562)Demographics, historical urine culture results, urine sediment results, clinical informationXGBoostAUC: 0.910
Sensitivity: 96.7% (95%CI: 96.52–96.86)
Specificity: 54.1%
(95%CI: 53.5–54.8%)
Sensitivity: 95.2% (95%CI: 95.0%–95.4%)
Specificity: 60.9% (95%CI: 60.3–61.6%)
Advanced analytics group of pediatric urology, 2019 (51)Observational cohort studyChildrenIdentifying children with an initial UTI who are at risk for rUTI and VUR500 children (440/79)Age, gender, race, weight, systolic blood pressure percentile, dysuria, urine albumin/creatinine ratio, prior antibiotic exposure, medicationOptimal classification treeAUC: 0.761
(95%CI: 0.714–0.808)a
None
Wilkes et al., 2018 (52)Single center, retrospectiveRoutine clinical practiceApplication of ML algorithms to the automated interpretation of urine steroid profiles4916 urine steroid profilesUp to 45 different features including steroid metabolites quantified by GC–MS and demographic dataWSRF model for binary classification, RF for multiclass classificationWSRF (normal versus abnormal): AUC of 0.955 (95%CI, 0.949–0.961).
RF (multiclass): mean balanced accuracy of 0.873 (0.865– 0.880)
None
Chortis et al., 2019 (53)Multicenter, longitudinalPatients with histologically confirmed ACC, who had undergone microscopically complete (R0) tumor resectionEvaluating the performance of urine steroid metabolomics as a tool for postoperative recurrence detection after microscopically complete (R0) resection of ACC135 patientsSteroid metabolites quantified by gas chromatography–mass spectrometryRFAUC: 0.89 (95%CI 0.86–0.91)
Sensitivity = specificity = 81%
None
Ni et al., 2021 (54)Single center, retrospectivePatients with ovarian carcinoma (73 malignant and 59 benign)Develop a classifier incorporating a urinary protein panel to classify benign and malignant ovarian tumors132 patients Train/test/extra validation set: 70/20/42Five proteins: WFDC2, PTMA, PVRL4, FIBA, and PVRL2RFAUC: 0.980, sensitivity 0.967, specificity 0.900Test: AUC: 0.970, sensitivity 0.900, specificity 0.900
Extra validation set: AUC 0.952, sensitivity 0.895, specificity 0.913
Bifarin et al., 2021 (55)Single center, prospective105 patients with RCC and 179 controlsRCC status prediction
Using multiplatform metabolomics
256 patients (62/194)7-metabolite panel for RCC that included 2-phenylacetamide, Lys-Ile (or Lys-leu), dibutylamine, hippuric acid, mannitol hippurate, 2-mercaptobenzothiazole, and N-acetyl-glucosaminic acidLinear SVMNot provided88% accuracy, 94% sensitivity, 85% specificity, and 0.98 AUC
Cani et al., 2022 (56)Single center, retrospective109 patients representing the spectrum of disease (benign to GG 5 prostate cancer)Development of a next-generation
RNA-sequencing assay for early detection of aggressive prostate cancer
109 patients
Training/validation split: 73/36
15 targets including TMPRSS2-ERG splicing isoforms, additional mRNAs, lncRNAs, and other current clinical biomarkersRF feature-reduction process followed by logistic regressionAUC: 0.82 (95%CI 0.65–0.98)None
Wang et al., 2021 (57)Multicenter, prospectivePatients with bladder cancer (n = 270) and controls (=261)Development of a gene expression assay for noninvasive detection of bladder cancer531 patients (211/320)32-gene signatureSVMAccuracy: 92.68%Accuracy: 89.9% (95%CI, 86%–93%)
Sensitivity: 82.6% (95%CI, 75%–88%)
Specificity: 95.1% (95%CI, 91%–98%)
AUC: 0.932 (95%CI: 90%–96%)
ReferenceFormatPatient populationPurposeData set (train/test split)Used featuresBest modelResult (cross)-validation setResult test set
Jang et al., 2023 (5)Multicenter, retrospectiveHeterogenous inpatient population (university hospital and diabetes center) for development; outpatients for external validationPredict impaired eGFR using ML models comprising urine test strip parameters, age, and gender357.434 patients (198.015/22.003/74.380/62.945; training/internal validation/external validation 1/external validation 2)Age, gender, 5 urine test strip parameters (protein, blood, glucose, pH, specific gravity)XGBoosteGFR <60 mL/min/1.73 m2:
AUC of 0.91 (95%CI: 0.91–0.92);
eGFR <45 mL/min/1.73 m2:
AUC of 0.94 (95%CI: 0.94–0.95)
Test set 1:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.91 (95%CI: 0.90–0.92);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.95 (95%CI: 0.93–0.96)
Test set 2:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.92 (95%CI: 0.91–0.93);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.94 (95%CI: 0.93–0.96)
Taylor et al., 2018 (49)Single center, retrospectiveEmergency departmentIdentifying the AI algorithm that has the highest diagnostic performance for UTI diagnosis using clinical symptoms and urine particle analysis results80.387 patients (64.310/16.077)Age, gender, WBC, nitrates, leukocytes, bacteria, blood, epithelial cells, history of previous UTI, dysuriaXGBoostAUC: 0.904 (95%CI: 0.898–0.910)
Sensitivity: 61.7% (95%CI: 60.0–63.3%)
Specificity: 94.9%
(95%CI: 94.5–95.3%)
AUC: 0.858 (95%CI: 0.853–0.863)
Sensitivity: 73.8% (95%CI: 72.3–75.2%)
Specificity: 89.2% (95%CI: 88.6–89.8%)
Burton RJ et al., 2019 (50)Single center, RetrospectiveHeterogenous hospital populationUsing AI to reduce the number of urinary cultures without compromising the detection of UTI212.554 urine reports (157.645/67.562)Demographics, historical urine culture results, urine sediment results, clinical informationXGBoostAUC: 0.910
Sensitivity: 96.7% (95%CI: 96.52–96.86)
Specificity: 54.1%
(95%CI: 53.5–54.8%)
Sensitivity: 95.2% (95%CI: 95.0%–95.4%)
Specificity: 60.9% (95%CI: 60.3–61.6%)
Advanced analytics group of pediatric urology, 2019 (51)Observational cohort studyChildrenIdentifying children with an initial UTI who are at risk for rUTI and VUR500 children (440/79)Age, gender, race, weight, systolic blood pressure percentile, dysuria, urine albumin/creatinine ratio, prior antibiotic exposure, medicationOptimal classification treeAUC: 0.761
(95%CI: 0.714–0.808)a
None
Wilkes et al., 2018 (52)Single center, retrospectiveRoutine clinical practiceApplication of ML algorithms to the automated interpretation of urine steroid profiles4916 urine steroid profilesUp to 45 different features including steroid metabolites quantified by GC–MS and demographic dataWSRF model for binary classification, RF for multiclass classificationWSRF (normal versus abnormal): AUC of 0.955 (95%CI, 0.949–0.961).
RF (multiclass): mean balanced accuracy of 0.873 (0.865– 0.880)
None
Chortis et al., 2019 (53)Multicenter, longitudinalPatients with histologically confirmed ACC, who had undergone microscopically complete (R0) tumor resectionEvaluating the performance of urine steroid metabolomics as a tool for postoperative recurrence detection after microscopically complete (R0) resection of ACC135 patientsSteroid metabolites quantified by gas chromatography–mass spectrometryRFAUC: 0.89 (95%CI 0.86–0.91)
Sensitivity = specificity = 81%
None
Ni et al., 2021 (54)Single center, retrospectivePatients with ovarian carcinoma (73 malignant and 59 benign)Develop a classifier incorporating a urinary protein panel to classify benign and malignant ovarian tumors132 patients Train/test/extra validation set: 70/20/42Five proteins: WFDC2, PTMA, PVRL4, FIBA, and PVRL2RFAUC: 0.980, sensitivity 0.967, specificity 0.900Test: AUC: 0.970, sensitivity 0.900, specificity 0.900
Extra validation set: AUC 0.952, sensitivity 0.895, specificity 0.913
Bifarin et al., 2021 (55)Single center, prospective105 patients with RCC and 179 controlsRCC status prediction
Using multiplatform metabolomics
256 patients (62/194)7-metabolite panel for RCC that included 2-phenylacetamide, Lys-Ile (or Lys-leu), dibutylamine, hippuric acid, mannitol hippurate, 2-mercaptobenzothiazole, and N-acetyl-glucosaminic acidLinear SVMNot provided88% accuracy, 94% sensitivity, 85% specificity, and 0.98 AUC
Cani et al., 2022 (56)Single center, retrospective109 patients representing the spectrum of disease (benign to GG 5 prostate cancer)Development of a next-generation
RNA-sequencing assay for early detection of aggressive prostate cancer
109 patients
Training/validation split: 73/36
15 targets including TMPRSS2-ERG splicing isoforms, additional mRNAs, lncRNAs, and other current clinical biomarkersRF feature-reduction process followed by logistic regressionAUC: 0.82 (95%CI 0.65–0.98)None
Wang et al., 2021 (57)Multicenter, prospectivePatients with bladder cancer (n = 270) and controls (=261)Development of a gene expression assay for noninvasive detection of bladder cancer531 patients (211/320)32-gene signatureSVMAccuracy: 92.68%Accuracy: 89.9% (95%CI, 86%–93%)
Sensitivity: 82.6% (95%CI, 75%–88%)
Specificity: 95.1% (95%CI, 91%–98%)
AUC: 0.932 (95%CI: 90%–96%)

Abbreviations: WSRF, weighted-subspace RF; FIBA, fibrinogen alpha chain; GG, grade group; PTMA, prothymosin alpha; PVRL2, poliovirus receptor-related 2; PVRL4, poliovirus receptor-related 4; WFDC2, WAP four-disulfide core domain protein 2.

aThe authors do not mention a sensitivity and specificity associated with the AUC.

Table 1.

Overview of the main ML applications in urinalysis included in this review.

ReferenceFormatPatient populationPurposeData set (train/test split)Used featuresBest modelResult (cross)-validation setResult test set
Jang et al., 2023 (5)Multicenter, retrospectiveHeterogenous inpatient population (university hospital and diabetes center) for development; outpatients for external validationPredict impaired eGFR using ML models comprising urine test strip parameters, age, and gender357.434 patients (198.015/22.003/74.380/62.945; training/internal validation/external validation 1/external validation 2)Age, gender, 5 urine test strip parameters (protein, blood, glucose, pH, specific gravity)XGBoosteGFR <60 mL/min/1.73 m2:
AUC of 0.91 (95%CI: 0.91–0.92);
eGFR <45 mL/min/1.73 m2:
AUC of 0.94 (95%CI: 0.94–0.95)
Test set 1:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.91 (95%CI: 0.90–0.92);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.95 (95%CI: 0.93–0.96)
Test set 2:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.92 (95%CI: 0.91–0.93);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.94 (95%CI: 0.93–0.96)
Taylor et al., 2018 (49)Single center, retrospectiveEmergency departmentIdentifying the AI algorithm that has the highest diagnostic performance for UTI diagnosis using clinical symptoms and urine particle analysis results80.387 patients (64.310/16.077)Age, gender, WBC, nitrates, leukocytes, bacteria, blood, epithelial cells, history of previous UTI, dysuriaXGBoostAUC: 0.904 (95%CI: 0.898–0.910)
Sensitivity: 61.7% (95%CI: 60.0–63.3%)
Specificity: 94.9%
(95%CI: 94.5–95.3%)
AUC: 0.858 (95%CI: 0.853–0.863)
Sensitivity: 73.8% (95%CI: 72.3–75.2%)
Specificity: 89.2% (95%CI: 88.6–89.8%)
Burton RJ et al., 2019 (50)Single center, RetrospectiveHeterogenous hospital populationUsing AI to reduce the number of urinary cultures without compromising the detection of UTI212.554 urine reports (157.645/67.562)Demographics, historical urine culture results, urine sediment results, clinical informationXGBoostAUC: 0.910
Sensitivity: 96.7% (95%CI: 96.52–96.86)
Specificity: 54.1%
(95%CI: 53.5–54.8%)
Sensitivity: 95.2% (95%CI: 95.0%–95.4%)
Specificity: 60.9% (95%CI: 60.3–61.6%)
Advanced analytics group of pediatric urology, 2019 (51)Observational cohort studyChildrenIdentifying children with an initial UTI who are at risk for rUTI and VUR500 children (440/79)Age, gender, race, weight, systolic blood pressure percentile, dysuria, urine albumin/creatinine ratio, prior antibiotic exposure, medicationOptimal classification treeAUC: 0.761
(95%CI: 0.714–0.808)a
None
Wilkes et al., 2018 (52)Single center, retrospectiveRoutine clinical practiceApplication of ML algorithms to the automated interpretation of urine steroid profiles4916 urine steroid profilesUp to 45 different features including steroid metabolites quantified by GC–MS and demographic dataWSRF model for binary classification, RF for multiclass classificationWSRF (normal versus abnormal): AUC of 0.955 (95%CI, 0.949–0.961).
RF (multiclass): mean balanced accuracy of 0.873 (0.865– 0.880)
None
Chortis et al., 2019 (53)Multicenter, longitudinalPatients with histologically confirmed ACC, who had undergone microscopically complete (R0) tumor resectionEvaluating the performance of urine steroid metabolomics as a tool for postoperative recurrence detection after microscopically complete (R0) resection of ACC135 patientsSteroid metabolites quantified by gas chromatography–mass spectrometryRFAUC: 0.89 (95%CI 0.86–0.91)
Sensitivity = specificity = 81%
None
Ni et al., 2021 (54)Single center, retrospectivePatients with ovarian carcinoma (73 malignant and 59 benign)Develop a classifier incorporating a urinary protein panel to classify benign and malignant ovarian tumors132 patients Train/test/extra validation set: 70/20/42Five proteins: WFDC2, PTMA, PVRL4, FIBA, and PVRL2RFAUC: 0.980, sensitivity 0.967, specificity 0.900Test: AUC: 0.970, sensitivity 0.900, specificity 0.900
Extra validation set: AUC 0.952, sensitivity 0.895, specificity 0.913
Bifarin et al., 2021 (55)Single center, prospective105 patients with RCC and 179 controlsRCC status prediction
Using multiplatform metabolomics
256 patients (62/194)7-metabolite panel for RCC that included 2-phenylacetamide, Lys-Ile (or Lys-leu), dibutylamine, hippuric acid, mannitol hippurate, 2-mercaptobenzothiazole, and N-acetyl-glucosaminic acidLinear SVMNot provided88% accuracy, 94% sensitivity, 85% specificity, and 0.98 AUC
Cani et al., 2022 (56)Single center, retrospective109 patients representing the spectrum of disease (benign to GG 5 prostate cancer)Development of a next-generation
RNA-sequencing assay for early detection of aggressive prostate cancer
109 patients
Training/validation split: 73/36
15 targets including TMPRSS2-ERG splicing isoforms, additional mRNAs, lncRNAs, and other current clinical biomarkersRF feature-reduction process followed by logistic regressionAUC: 0.82 (95%CI 0.65–0.98)None
Wang et al., 2021 (57)Multicenter, prospectivePatients with bladder cancer (n = 270) and controls (=261)Development of a gene expression assay for noninvasive detection of bladder cancer531 patients (211/320)32-gene signatureSVMAccuracy: 92.68%Accuracy: 89.9% (95%CI, 86%–93%)
Sensitivity: 82.6% (95%CI, 75%–88%)
Specificity: 95.1% (95%CI, 91%–98%)
AUC: 0.932 (95%CI: 90%–96%)
ReferenceFormatPatient populationPurposeData set (train/test split)Used featuresBest modelResult (cross)-validation setResult test set
Jang et al., 2023 (5)Multicenter, retrospectiveHeterogenous inpatient population (university hospital and diabetes center) for development; outpatients for external validationPredict impaired eGFR using ML models comprising urine test strip parameters, age, and gender357.434 patients (198.015/22.003/74.380/62.945; training/internal validation/external validation 1/external validation 2)Age, gender, 5 urine test strip parameters (protein, blood, glucose, pH, specific gravity)XGBoosteGFR <60 mL/min/1.73 m2:
AUC of 0.91 (95%CI: 0.91–0.92);
eGFR <45 mL/min/1.73 m2:
AUC of 0.94 (95%CI: 0.94–0.95)
Test set 1:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.91 (95%CI: 0.90–0.92);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.95 (95%CI: 0.93–0.96)
Test set 2:
eGFR <60 mL/min/ 1.73 m2:
AUC of 0.92 (95%CI: 0.91–0.93);
eGFR <45 mL/min/ 1.73 m2:
AUC of 0.94 (95%CI: 0.93–0.96)
Taylor et al., 2018 (49)Single center, retrospectiveEmergency departmentIdentifying the AI algorithm that has the highest diagnostic performance for UTI diagnosis using clinical symptoms and urine particle analysis results80.387 patients (64.310/16.077)Age, gender, WBC, nitrates, leukocytes, bacteria, blood, epithelial cells, history of previous UTI, dysuriaXGBoostAUC: 0.904 (95%CI: 0.898–0.910)
Sensitivity: 61.7% (95%CI: 60.0–63.3%)
Specificity: 94.9%
(95%CI: 94.5–95.3%)
AUC: 0.858 (95%CI: 0.853–0.863)
Sensitivity: 73.8% (95%CI: 72.3–75.2%)
Specificity: 89.2% (95%CI: 88.6–89.8%)
Burton RJ et al., 2019 (50)Single center, RetrospectiveHeterogenous hospital populationUsing AI to reduce the number of urinary cultures without compromising the detection of UTI212.554 urine reports (157.645/67.562)Demographics, historical urine culture results, urine sediment results, clinical informationXGBoostAUC: 0.910
Sensitivity: 96.7% (95%CI: 96.52–96.86)
Specificity: 54.1%
(95%CI: 53.5–54.8%)
Sensitivity: 95.2% (95%CI: 95.0%–95.4%)
Specificity: 60.9% (95%CI: 60.3–61.6%)
Advanced analytics group of pediatric urology, 2019 (51)Observational cohort studyChildrenIdentifying children with an initial UTI who are at risk for rUTI and VUR500 children (440/79)Age, gender, race, weight, systolic blood pressure percentile, dysuria, urine albumin/creatinine ratio, prior antibiotic exposure, medicationOptimal classification treeAUC: 0.761
(95%CI: 0.714–0.808)a
None
Wilkes et al., 2018 (52)Single center, retrospectiveRoutine clinical practiceApplication of ML algorithms to the automated interpretation of urine steroid profiles4916 urine steroid profilesUp to 45 different features including steroid metabolites quantified by GC–MS and demographic dataWSRF model for binary classification, RF for multiclass classificationWSRF (normal versus abnormal): AUC of 0.955 (95%CI, 0.949–0.961).
RF (multiclass): mean balanced accuracy of 0.873 (0.865– 0.880)
None
Chortis et al., 2019 (53)Multicenter, longitudinalPatients with histologically confirmed ACC, who had undergone microscopically complete (R0) tumor resectionEvaluating the performance of urine steroid metabolomics as a tool for postoperative recurrence detection after microscopically complete (R0) resection of ACC135 patientsSteroid metabolites quantified by gas chromatography–mass spectrometryRFAUC: 0.89 (95%CI 0.86–0.91)
Sensitivity = specificity = 81%
None
Ni et al., 2021 (54)Single center, retrospectivePatients with ovarian carcinoma (73 malignant and 59 benign)Develop a classifier incorporating a urinary protein panel to classify benign and malignant ovarian tumors132 patients Train/test/extra validation set: 70/20/42Five proteins: WFDC2, PTMA, PVRL4, FIBA, and PVRL2RFAUC: 0.980, sensitivity 0.967, specificity 0.900Test: AUC: 0.970, sensitivity 0.900, specificity 0.900
Extra validation set: AUC 0.952, sensitivity 0.895, specificity 0.913
Bifarin et al., 2021 (55)Single center, prospective105 patients with RCC and 179 controlsRCC status prediction
Using multiplatform metabolomics
256 patients (62/194)7-metabolite panel for RCC that included 2-phenylacetamide, Lys-Ile (or Lys-leu), dibutylamine, hippuric acid, mannitol hippurate, 2-mercaptobenzothiazole, and N-acetyl-glucosaminic acidLinear SVMNot provided88% accuracy, 94% sensitivity, 85% specificity, and 0.98 AUC
Cani et al., 2022 (56)Single center, retrospective109 patients representing the spectrum of disease (benign to GG 5 prostate cancer)Development of a next-generation
RNA-sequencing assay for early detection of aggressive prostate cancer
109 patients
Training/validation split: 73/36
15 targets including TMPRSS2-ERG splicing isoforms, additional mRNAs, lncRNAs, and other current clinical biomarkersRF feature-reduction process followed by logistic regressionAUC: 0.82 (95%CI 0.65–0.98)None
Wang et al., 2021 (57)Multicenter, prospectivePatients with bladder cancer (n = 270) and controls (=261)Development of a gene expression assay for noninvasive detection of bladder cancer531 patients (211/320)32-gene signatureSVMAccuracy: 92.68%Accuracy: 89.9% (95%CI, 86%–93%)
Sensitivity: 82.6% (95%CI, 75%–88%)
Specificity: 95.1% (95%CI, 91%–98%)
AUC: 0.932 (95%CI: 90%–96%)

Abbreviations: WSRF, weighted-subspace RF; FIBA, fibrinogen alpha chain; GG, grade group; PTMA, prothymosin alpha; PVRL2, poliovirus receptor-related 2; PVRL4, poliovirus receptor-related 4; WFDC2, WAP four-disulfide core domain protein 2.

aThe authors do not mention a sensitivity and specificity associated with the AUC.

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