Last updated: 2026-03-06

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Knit directory: Serology-Analysis/

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Load Packages

suppressPackageStartupMessages({

  # Data handling
  library(tidyverse)
  library(data.table)
  library(magrittr)
  library(janitor)
  library(here)
  library(scales)
  library(table1)
  library(tableone)
  library(flextable)
  library(gtsummary)
  library(openxlsx)
  library(writexl)
  library(readxl)
  # Visualization
  library(ggplot2)    
  library(ggpubr)
  library(ggrepel)
  library(ggbeeswarm)
  library(ggcorrplot)
  library(corrplot)
  library(pheatmap)
  library(ComplexHeatmap)
  library(circlize)
  library(RColorBrewer)
  library(EnhancedVolcano)
  library(plotly)
  library(patchwork)
  library(cowplot)
  library(gridExtra)
  library(grid)
  library(ggpattern)
  # Statistics
  library(rstatix)
  library(multcomp)
  library(car)
  library(Hmisc)
  library(MASS)       
  library(MuMIn)
  library(broom)
  library(glmnet)
  library(logistf)
  library(drc)
  library(caret)
  library(mice)
  library(pROC)
  # Clustering
  library(randomForest)
  library(factoextra)
  library(cluster)
  library(Rtsne)
  library(umap)
  library(dbscan)
  library(kernlab)
  library(Seurat)
  # Others
  library(ImmunoLogic)
  
})

Define Filepath

  basedir <- here()

Read Data (Cohort 1, Cohort 2)

# Import Phenotypes
  table_cluster <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_phenotypes.xlsx")) 

# Import BMP4 Data
  table_bmp4_cohort1 <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_BMP4_Cohort1.xlsx")) 
  
  table_bmp4_cohort2 <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_BMP4_Cohort2.xlsx"))
  
# Combine Tables
  table_bmp4_myo <- rbind(table_bmp4_cohort1, table_bmp4_cohort2) %>%
                         dplyr::select(-Cohort)

# Import Serology Data
  table_clindat_cohort1 <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_ClinicalData_Cohort1.xlsx")) %>%
                           dplyr::select(Study_ID, NTproBNP, LV_EF, Trop_I, CRP)

  table_clindat_cohort2 <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_ClinicalData_Cohort2.xlsx")) %>%
                           dplyr::select(Study_ID, NTproBNP, LV_EF, Trop_I, CRP)
  
# Combine tables
  table_clindat_myo <- rbind(table_clindat_cohort1, table_clindat_cohort2)
  
# Import Luminex Data
  table_lum_cohort1 <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_Lum_Cohort1_DL_corr.xlsx")) %>%
                       dplyr::select(-EOTAXIN) 
  
  table_lum_cohort2 <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_Lum_Cohort2_DL_corr.xlsx")) %>%
                       dplyr::select(-EOTAXIN) 

# Combine tables
  table_lum_myo <- rbind(table_lum_cohort1, table_lum_cohort2)
  
# Combine all data tables
  table_all_myo <-  table_lum_myo %>%
                    left_join(table_bmp4_myo, by = "Study_ID") %>%
                    left_join(table_clindat_myo, by = "Study_ID")

Multiple Imputation (Myo)

# Impute missing values
  imputed_data <- mice(table_all_myo, m = 5, method = 'pmm', maxit = 5, seed = 1234)

 iter imp variable
  1   1  NTproBNP  LV_EF  Trop_I
  1   2  NTproBNP  LV_EF  Trop_I
  1   3  NTproBNP  LV_EF  Trop_I
  1   4  NTproBNP  LV_EF  Trop_I
  1   5  NTproBNP  LV_EF  Trop_I
  2   1  NTproBNP  LV_EF  Trop_I
  2   2  NTproBNP  LV_EF  Trop_I
  2   3  NTproBNP  LV_EF  Trop_I
  2   4  NTproBNP  LV_EF  Trop_I
  2   5  NTproBNP  LV_EF  Trop_I
  3   1  NTproBNP  LV_EF  Trop_I
  3   2  NTproBNP  LV_EF  Trop_I
  3   3  NTproBNP  LV_EF  Trop_I
  3   4  NTproBNP  LV_EF  Trop_I
  3   5  NTproBNP  LV_EF  Trop_I
  4   1  NTproBNP  LV_EF  Trop_I
  4   2  NTproBNP  LV_EF  Trop_I
  4   3  NTproBNP  LV_EF  Trop_I
  4   4  NTproBNP  LV_EF  Trop_I
  4   5  NTproBNP  LV_EF  Trop_I
  5   1  NTproBNP  LV_EF  Trop_I
  5   2  NTproBNP  LV_EF  Trop_I
  5   3  NTproBNP  LV_EF  Trop_I
  5   4  NTproBNP  LV_EF  Trop_I
  5   5  NTproBNP  LV_EF  Trop_I
# Check the imputed data
  densityplot(imputed_data, col=c("grey", "blue"), pch = c(1, 20))
Warning! The custom fig.path you set was ignored by workflowr.
# Create a data set with the observed and completed data
  table_imp <- complete(imputed_data, 1)

Abandance Bubble Plot: Selection of parameters

# Subset Myo
  table_abund_myo <-  table_imp %>%
                      dplyr::select("Study_ID", "Cohort", "IL_2R", "HGF", "CXCL9", "CXCL10", 
                                     "CCL3", "CCL4", "CXCL8", "IL_6",
                                     "Grem_1", "BMP4","Grem_2", "NTproBNP") 

# Add Healthy as reference
  table_lum_healthy <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_Lum_Healthy_DL_corr.xlsx")) %>%
                       dplyr::select("Study_ID", "IL_2R", "HGF", "CXCL9", "CXCL10", 
                                     "CCL3", "CCL4", "CXCL8", "IL_6")
  
  table_bmp4_healthy <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_BMP4_Healthy.xlsx")) %>%
                        dplyr::select("Study_ID", "Cohort", "BMP4", "Grem_1", "Grem_2")
  
  table_clindat_healthy <- openxlsx::read.xlsx(file.path(basedir, "data", "Table_Serology_Healthy.xlsx")) %>%
                           dplyr::select(Study_ID, NTproBNP)
  
  table_healthy <- table_lum_healthy %>%
                   left_join(table_bmp4_healthy, by = "Study_ID") %>%
                   left_join(table_clindat_healthy, by = "Study_ID")
  
  table_abund_all <-  bind_rows(table_abund_myo, table_healthy)

# Prepare data table for bubble plot
  # Create the loop vector
    parameters <- names(which(sapply(table_abund_all, is.numeric) == TRUE)) 
    
  # Prepare data table 
    table_para <- table_abund_all %>%
                  pivot_longer(cols = where(is.numeric),
                               names_to = "Parameter",
                               values_to = "Parameter_val")
    
# Calculate mean expression for the healthy cohort
  healthy_stats <- table_para %>%
                   filter(Cohort == "Healthy") %>%
                   group_by(Parameter) %>%
                   summarise(mean_expr_healthy = mean(Parameter_val, na.rm = TRUE))

# Calculate mean expression for each diseased cohort
  cohorts_stats <-  table_para %>%
                    filter(Cohort != "Healthy") %>%
                    group_by(Cohort, Parameter) %>%
                    summarise(mean_expr_diseased = mean(Parameter_val, na.rm = TRUE)) %>%
                    left_join(healthy_stats, by = "Parameter") %>%
                    mutate(log2_fold_change = log2(mean_expr_diseased / mean_expr_healthy))

  
# Calculate percentage of how many patients have a fold change > 1
  diseased_percentage_fc_increase <-  table_para %>%
                                      filter(Cohort != "Healthy") %>%
                                      group_by(Cohort, Parameter) %>%
                                      left_join( healthy_stats, by = "Parameter") %>%
                                      mutate(log2_fc = log2(Parameter_val / mean_expr_healthy)) %>%
                                      mutate(fc_1 = log2_fc >1) %>%
                                      summarise(percentage_fc_1 = mean(fc_1, na.rm = TRUE) * 100)
  
    # Merge stats tables
      cohorts_stats <- cohorts_stats %>%
                       left_join(diseased_percentage_fc_increase,by = c("Cohort", "Parameter"))
      
    # Calculate Mean of both Cohorts
      combined_from_cohorts <-  cohorts_stats %>%
                                group_by(Parameter) %>%
                                summarise(percentage_fc_1_mean = mean(percentage_fc_1, na.rm = TRUE),
                                          log2_fc_mean = mean(log2_fold_change, na.rm = TRUE))
      
    # Order Parameter according to abandance
      combined_from_cohorts <-  combined_from_cohorts %>%
                                arrange(desc(percentage_fc_1_mean)) %>%
                                mutate(Parameter = factor(Parameter, levels = unique(Parameter)))
      
# Create the Bubble Plot
  bubble_plot <- ggplot(combined_from_cohorts, aes(x = Parameter,y = 1, 
                                                   size = abs(percentage_fc_1_mean), color = log2_fc_mean)) + 
                  geom_point(alpha = 1) + 
                  geom_text(aes(label = round(percentage_fc_1_mean, 1)), 
                            color = "black", size = 3, vjust = -5) +
                  scale_size(range = c(2, 8)) +
                  scale_color_gradient2(low = "royalblue", mid = "white", high = "darkred", midpoint = 0) +
                  labs(title = "Fold Change (Log2) by Parameter",
                       x = "Parameter", y = "", 
                       size = "Percentage of Patients (FC > 1)", color = "Log2 Fold Change") +
                  theme_classic() +
                  theme(axis.text.x = element_text(angle = 45, hjust = 1))

# Display the plot
  print(bubble_plot)
Warning! The custom fig.path you set was ignored by workflowr.

Cardiac dysfunction

# Subset data
  table_lvef <-  table_imp %>%
                 dplyr::select("Study_ID", "LV_EF") 

# Calculate percentage of low LVEF
  percent_lvef_low <- table_lvef %>%
                      summarise(n_total = n(),
                                n_low = sum(LV_EF < 52, na.rm = TRUE),
                                percent_low = (n_low / n_total) * 100 )

# Label low LVEF
  table_lvef <- table_imp %>%
                mutate(lvef_reduced = case_when(
                        LV_EF < 52 ~ "Reduced",
                        TRUE ~ "Normal"))

  table_lvef$lvef_reduced <- factor(table_lvef$lvef_reduced, levels = c("Normal", "Reduced"))

# Plot
  plot_lvef <-  ggplot(table_lvef, aes(x = "", y = LV_EF)) +
                geom_boxplot(color = "black", outlier.shape = NA, width = 0.6, alpha = 0.4) +
                geom_point(aes(fill = lvef_reduced), shape = 21, size = 3,
                           color = "black", position = position_jitter(width = 0.2, height = 0)) +
                scale_fill_manual(values = c("Normal" = "grey", "Reduced" = "darkred")) +
                scale_y_continuous(limits = c(0, 80), expand = c(0, 0)) +
                labs(x = NULL, y = "LVEF (%)") +
                theme_classic() +
                theme(axis.title.x = element_blank(),
                      axis.text.x  = element_blank(),
                      axis.ticks.x = element_blank(),
                      legend.position = "right") +
                annotate("text",x = 1, y = 75, size = 5,fontface = "bold", label = paste0(round(percent_lvef_low$percent_low, 0), 
                                                                                          "% of AM patients\nLVEF <52%"))
  
  print(plot_lvef)
Warning! The custom fig.path you set was ignored by workflowr.

Comparison Parameters in immuno-clinical phenotypes

# Define colors for plots
  cluster_colors <- c("Severe" = "plum4",
                      "Mild" = "cadetblue4")

# Prepare data table 
   table_para <- table_cluster %>%
                 pivot_longer(cols = where(is.numeric),
                              names_to = "Parameter",
                              values_to = "Parameter_val")

# Put outcome as ordered factor
  table_para$phenotype <- factor(table_para$phenotype,
                                 levels = c("Mild", "Severe"))
  
# Calculate Stats
   # Wilcox Test
    stat.test <- table_para %>%
                 group_by(Parameter) %>%
                 wilcox_test(Parameter_val ~ phenotype) %>%
                 add_significance()  %>%
                 mutate(p_adj = p.adjust(p, method = "BH")) 
    
    # Get max value per parameter (for p-value position)
      max_y <- table_para %>%
               group_by(Parameter) %>%
               summarise(max_val = max(Parameter_val, na.rm = TRUE))
      
    # Get min value per parameter (for y limits)
      min_y <- table_para %>%
               group_by(Parameter) %>%
               summarise(min_val = min(Parameter_val, na.rm = TRUE))
    
    # Combine with max_y info for plotting
      stat.test <-  stat.test %>%
                    left_join(max_y, by = "Parameter") %>%
                    left_join(min_y, by = "Parameter") %>%
                    mutate(y.position = max_val)

# Define biomarkers
  biomarkers <- c("NTproBNP", "CXCL10", "CXCL9", 
                  "IL_2R", "CCL4", "HGF", "Grem_2")
  
  y_settings <- list(NTproBNP = list(limits = c(NA, 100000), breaks = c(10, 100, 1000, 10000, 100000)),
                     CXCL10 = list(limits = c(NA, 3000), breaks = c(30, 100, 300, 1000, 3000)),
                     CXCL9  = list(limits = c(NA, 10000),  breaks = c(100, 300, 1000, 3000, 10000)),
                     IL_2R = list(limits = c(NA, 30000), breaks = c(30, 100, 300, 1000, 3000, 10000, 30000)),
                     CCL4 = list(limits = c(NA, 30000), breaks = c(30, 100, 300, 1000, 3000, 10000, 30000)),
                     HGF  = list(limits = c(NA, 30000), breaks = c(30, 100, 300, 1000, 3000, 10000, 30000)),
                     Grem_2  = list(limits = c(NA, 100000),  breaks = c(300, 1000, 3000, 10000, 30000, 100000)))

# Define axis labels for each biomarker
  biomarker_labels <- c("NT-proBNP (ng/l)", "CXCL10 (pg/ml)", "CXCL9 (pg/ml)",
                        "IL-2R (pg/ml)", "CCL4 (pg/ml)", "HGF (pg/ml)", "Gremlin-2 (pg/ml)")
  names(biomarker_labels) <- biomarkers
  
# Create a plot list
  plots_list <- list()
    
    for (param in biomarkers) 
     
      {
        # Filter for the data 
          temp_data <- table_para %>% 
                       filter(Parameter == param) 
          
          temp_stat_test <- stat.test %>% 
                            filter(Parameter == param) %>% 
                            mutate(p_adj_label = ifelse(p_adj < 0.001, "<0.001", sprintf("%.3f", p_adj)))
        # Axis settings
          y_lim <- y_settings[[param]]$limits
          y_brk <- y_settings[[param]]$breaks 
  
          plot <-  ggplot(temp_data, aes(x = phenotype, y = Parameter_val)) +
                        geom_boxplot(aes(fill = phenotype), color = "black", outlier.shape = NA, 
                                     width = 0.6, alpha = 0.4) +
                        geom_point(shape = 21, size = 3, color = "black", aes(fill = phenotype),
                                 position = position_jitter(width = 0.2, height = 0)) +
                        scale_fill_manual(values = cluster_colors) +
                        scale_y_log10(labels = function(x) format(x, scientific = FALSE, trim = TRUE),
                                  limits = y_lim, breaks = y_brk, expand = expansion(mult = c(0.05, 0))) +
                        stat_pvalue_manual(temp_stat_test, label = "p_adj_label", 
                                           y.position = log10(temp_stat_test$y.position),
                                           step.increase = 0.1,
                                           tip.length = 0) +
                        labs(x = NULL, y = biomarker_labels[[param]]) +
                        theme_classic()  +
                        theme(axis.title.x = element_blank(),
                              axis.text.x  = element_blank(),
                              axis.ticks.x = element_blank(),
                              legend.position = "none")
  
          plots_list[[param]] <- plot
    }
  
# Plot LVEF
  # Filter for the data 
          temp_data <- table_para %>% 
                       filter(Parameter == "LV_EF") 
          
          temp_stat_test <- stat.test %>% 
                            filter(Parameter == "LV_EF") %>% 
                            mutate(p_adj_label = ifelse(p_adj < 0.001, "<0.001", sprintf("%.3f", p_adj)))
  
          plot_lvef <-  ggplot(temp_data, aes(x = phenotype, y = Parameter_val)) +
                                geom_boxplot(aes(fill = phenotype), color = "black", outlier.shape = NA, 
                                             width = 0.6, alpha = 0.4) +
                                geom_point(shape = 21, size = 3, color = "black", aes(fill = phenotype),
                                         position = position_jitter(width = 0.2, height = 0)) +
                                scale_fill_manual(values = cluster_colors) +
                                scale_y_continuous(limits = c(0, 80), expand = c(0, 0)) +
                                stat_pvalue_manual(temp_stat_test, label = "p_adj_label", 
                                                   y.position = temp_stat_test$y.position,
                                                   step.increase = 0.1,
                                                   tip.length = 0) +
                                labs(x = NULL, y = "LVEF (%)") +
                                theme_classic()  +
                                theme(axis.title.x = element_blank(),
                                      axis.text.x  = element_blank(),
                                      axis.ticks.x = element_blank(),
                                      legend.position = "none")
  
# Combine plots to a panel
  panel <-  ggarrange(plotlist = c(plot_lvef, plots_list),
                                ncol = 4, nrow = 2, common.legend = TRUE) 
      
  print(panel)
Warning! The custom fig.path you set was ignored by workflowr.

Correlation Plot

# Define cluster colors
  cluster_colors <- c("Severe" = "plum4",
                      "Mild" = "cadetblue4",
                      "Healthy" = "lightgrey")

# Healthy patients
  table_healthy <-  table_healthy %>%
                    dplyr::select(Study_ID, CXCL10, Grem_2, NTproBNP) %>%
                    mutate(phenotype = "Healthy")

# Clustered patients
  table_cluster_01 <- table_cluster %>%
                      dplyr::select(Study_ID, phenotype) %>%
                      left_join(table_imp %>% dplyr::select(Study_ID, CXCL10, Grem_2, NTproBNP),by = "Study_ID")
  
# Combine
  table_corr <- rbind(table_cluster_01, table_healthy)

# Compute Spearman correlation
  cor_test <- cor.test(table_corr$Grem_2, table_corr$NTproBNP, method = "spearman")
  
  plot <-   ggplot(table_corr, aes(y = Grem_2, x = NTproBNP, color = phenotype)) +
            geom_point(aes(fill = phenotype, size = CXCL10),
                           shape = 21, color = "black", alpha = 0.8) +
            scale_size_continuous(name = "CXCL10 (pg/ml)",
                                  range = c(2, 15),
                                  breaks = c(35, 50, 100),
                                  labels = c("35", "50", "100"),
                                  limits = c(35, 600)) +
            geom_smooth(method = "lm", se = TRUE, color = "black") +
            scale_fill_manual(values = cluster_colors)  +
            scale_x_log10(labels = function(y) format(y, scientific = FALSE, trim = TRUE),
                          breaks = c(10, 100, 1000, 10000, 100000),
                          limits = c(10, 100000)) +
            scale_y_log10(labels = function(x) format(x, scientific = FALSE, trim = TRUE),
                                 limits = c(NA, 30000), breaks = c(300, 1000, 3000, 10000, 30000),
                                 expand = expansion(mult = c(0.05, 0), add = c(0,0))) +
            theme_classic() +
            labs(y = "Gremlin-2 (pg/ml)", x = "NT-proBNP (ng/l)") +
            annotate("text", 
                     y = min(table_corr$Grem_2, na.rm = TRUE)*1.4,
                     x = max(table_corr$NTproBNP, na.rm = TRUE)*0.8,
                     label = paste0("r = ", round(cor_test$estimate, 2),
                                    "\np = ", ifelse(cor_test$p.value < 0.001, "< 0.001", 
                                                     signif(cor_test$p.value, 3))),
                     hjust = 0,vjust = 1, size = 4) +
            scale_color_manual(values = cluster_colors) 
  
  print(plot)
Warning! The custom fig.path you set was ignored by workflowr.

Roc Curve

# Data preparation
  table_roc <- table_cluster %>%
               dplyr::select(Study_ID, phenotype, CXCL9, IL_2R, CCL4, HGF, NTproBNP) %>%
               mutate(phenotype = factor(phenotype, levels = c("Mild", "Severe")),
                      outcome_binary = ifelse(phenotype == "Severe", 1, 0))
                      
# Select predictors
  param <- c("CXCL9", "IL_2R", "CCL4", "HGF", "NTproBNP")
  biomarker_labels <- c(CXCL9 = "CXCL9", IL_2R = "IL_2R", CCL4 = "CCL4", HGF = "HGF", NTproBNP = "NT-proBNP", Full = "Full model")
  
# Initialize storage
  roc_list <- list()

# Create ROC Curve for each parameter
  for (p in param) 
    
  {
    roc_obj <- roc(response = table_roc$outcome_binary,
                   predictor = table_roc[[p]],
                   levels = c(0, 1),
                   direction = "auto",
                   ci = TRUE,
                   legacy.axes = TRUE)
    
    roc_list[[p]] <- roc_obj
  }
  
# Create ROC Curve for full model
    table_roc <- table_cluster %>%
                 dplyr::select("Study_ID", "phenotype", "IL_2R", "HGF", "CXCL9", "CXCL10", 
                                 "CCL4", "Grem_2", "NTproBNP", "LV_EF") %>%
                 mutate(phenotype = factor(phenotype, levels = c("Mild", "Severe")),
                        outcome_binary = ifelse(phenotype == "Severe", 1, 0))
    
    param = c("IL_2R", "HGF", "CXCL9", "CXCL10", "CCL4", "Grem_2", "NTproBNP", "LV_EF")
  
  # Create formula dynamically
    formula_str <- paste("outcome_binary ~", paste(param, collapse = " + "))
    
    model <- glm(as.formula(formula_str), 
                 data = table_roc, 
                 family = binomial)
    
    summary(model)

Call:
glm(formula = as.formula(formula_str), family = binomial, data = table_roc)

Coefficients:
              Estimate Std. Error z value Pr(>|z|)   
(Intercept) -3.720e+00  2.987e+00  -1.245  0.21301   
IL_2R        6.959e-04  3.514e-04   1.980  0.04766 * 
HGF          4.556e-04  3.376e-04   1.350  0.17715   
CXCL9        2.433e-03  3.088e-03   0.788  0.43085   
CXCL10       3.433e-02  1.206e-02   2.848  0.00440 **
CCL4         2.627e-04  5.739e-04   0.458  0.64712   
Grem_2       2.500e-04  7.730e-05   3.234  0.00122 **
NTproBNP     1.384e-04  9.303e-05   1.488  0.13680   
LV_EF       -1.183e-01  4.878e-02  -2.426  0.01528 * 
---
Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1

(Dispersion parameter for binomial family taken to be 1)

    Null deviance: 142.701  on 102  degrees of freedom
Residual deviance:  35.948  on  94  degrees of freedom
AIC: 53.948

Number of Fisher Scoring iterations: 9
  # Predicted probabilities (prob of being Severe)
    predictions <- predict(model, type = "response")

# Compute ROC curve for combined model
  roc_full <- roc(response = table_roc$outcome_binary,
                  predictor = predictions,
                  levels = c(0, 1),
                  direction = "<",
                  ci = TRUE)
  
  roc_list[["Full"]] <- roc_full

  # AUC & CI values
  auc_vals <- sapply(roc_list, function(x) as.numeric(auc(x)))
  auc_ci   <- lapply(roc_list, function(x) ci.auc(x))
  
# Create Legend
  legend_text <- mapply(function(name, auc, ci) {
                        paste0(biomarker_labels[name],
                                " (AUC = ", round(auc,2),
                                ", 95% CI: ", round(ci[1],2),
                                "–", round(ci[3],2), ")")},
                 names(roc_list), auc_vals,auc_ci)
  
# Combine ROC curves into ggplot
  roc_plot <- ggroc(roc_list, legacy.axes = TRUE) +
              geom_abline(intercept = 0, slope = 1, linetype = "dashed", color = "grey") +
              scale_color_manual(values = c("lightblue", "deepskyblue3", "navyblue", "lightblue4", "grey", "plum4"),
                                 labels = legend_text) +
              theme_classic() +
              theme(panel.border = element_rect(color = "black", fill = NA, linewidth = 1),
                    legend.position = "right",
                    legend.direction = "vertical") +
              labs(x = "1 - Specificity", 
                   y = "Sensitivity",
                   color = "Legend") +
              coord_equal()
  
  print(roc_plot)
Warning! The custom fig.path you set was ignored by workflowr.

session info

sessionInfo()
R version 4.4.3 (2025-02-28)
Platform: aarch64-apple-darwin20
Running under: macOS 26.3

Matrix products: default
BLAS:   /Library/Frameworks/R.framework/Versions/4.4-arm64/Resources/lib/libRblas.0.dylib 
LAPACK: /Library/Frameworks/R.framework/Versions/4.4-arm64/Resources/lib/libRlapack.dylib;  LAPACK version 3.12.0

locale:
[1] en_US.UTF-8/en_US.UTF-8/en_US.UTF-8/C/en_US.UTF-8/en_US.UTF-8

time zone: Europe/Zurich
tzcode source: internal

attached base packages:
[1] grid      stats     graphics  grDevices utils     datasets  methods  
[8] base     

other attached packages:
 [1] ImmunoLogic_0.0.0.9000 Seurat_5.3.1           SeuratObject_5.2.0    
 [4] sp_2.2-0               kernlab_0.9-33         dbscan_1.2-0          
 [7] umap_0.2.10.0          Rtsne_0.17             cluster_2.1.8         
[10] factoextra_1.0.7       randomForest_4.7-1.2   pROC_1.19.0.1         
[13] mice_3.18.0            caret_7.0-1            lattice_0.22-6        
[16] drc_3.0-1              logistf_1.26.1         glmnet_4.1-10         
[19] Matrix_1.7-2           broom_1.0.11           MuMIn_1.48.11         
[22] Hmisc_5.2-3            car_3.1-3              carData_3.0-5         
[25] multcomp_1.4-28        TH.data_1.1-4          MASS_7.3-65           
[28] survival_3.8-3         mvtnorm_1.3-3          rstatix_0.7.3         
[31] ggpattern_1.2.1        gridExtra_2.3          cowplot_1.2.0         
[34] patchwork_1.3.2        plotly_4.11.0          EnhancedVolcano_1.24.0
[37] RColorBrewer_1.1-3     circlize_0.4.16        ComplexHeatmap_2.22.0 
[40] pheatmap_1.0.12        corrplot_0.95          ggcorrplot_0.1.4.1    
[43] ggbeeswarm_0.7.2       ggrepel_0.9.6          ggpubr_0.6.2          
[46] readxl_1.4.5           writexl_1.5.0          openxlsx_4.2.5.2      
[49] gtsummary_2.4.0        flextable_0.9.6        tableone_0.13.2       
[52] table1_1.4.3           scales_1.4.0           here_1.0.2            
[55] janitor_2.2.0          magrittr_2.0.4         data.table_1.17.8     
[58] lubridate_1.9.4        forcats_1.0.1          stringr_1.6.0         
[61] dplyr_1.1.4            purrr_1.2.0            readr_2.1.6           
[64] tidyr_1.3.1            tibble_3.3.0           ggplot2_4.0.1         
[67] tidyverse_2.0.0       

loaded via a namespace (and not attached):
  [1] IRanges_2.40.1          nnet_7.3-20             goftest_1.2-3          
  [4] vctrs_0.6.5             spatstat.random_3.4-3   digest_0.6.39          
  [7] png_0.1-8               shape_1.4.6.1           git2r_0.36.2           
 [10] alabama_2023.1.0        deldir_2.0-4            httpcode_0.3.0         
 [13] parallelly_1.45.1       fontLiberation_0.1.0    reshape2_1.4.5         
 [16] httpuv_1.6.16           foreach_1.5.2           BiocGenerics_0.52.0    
 [19] withr_3.0.2             xfun_0.54               crul_1.4.2             
 [22] emmeans_1.10.4          systemfonts_1.3.1       ragg_1.5.0             
 [25] zoo_1.8-14              GlobalOptions_0.1.3     gtools_3.9.5           
 [28] pbapply_1.7-4           Formula_1.2-5           promises_1.5.0         
 [31] otel_0.2.0              httr_1.4.7              globals_0.18.0         
 [34] fitdistrplus_1.2-4      rstudioapi_0.17.1       pan_1.9                
 [37] miniUI_0.1.2            generics_0.1.4          base64enc_0.1-3        
 [40] curl_7.0.0              S4Vectors_0.44.0        mitools_2.4            
 [43] polyclip_1.10-7         quadprog_1.5-8          xtable_1.8-4           
 [46] doParallel_1.0.17       evaluate_1.0.5          hms_1.1.4              
 [49] irlba_2.3.5.1           colorspace_2.1-2        polynom_1.4-1          
 [52] ROCR_1.0-11             reticulate_1.44.1       spatstat.data_3.1-9    
 [55] lmtest_0.9-40           snakecase_0.11.1        later_1.4.4            
 [58] spatstat.geom_3.6-1     future.apply_1.20.0     scattermore_1.2        
 [61] survey_4.4-2            matrixStats_1.5.0       RcppAnnoy_0.0.22       
 [64] class_7.3-23            pillar_1.11.1           nlme_3.1-167           
 [67] iterators_1.0.14        compiler_4.4.3          RSpectra_0.16-2        
 [70] stringi_1.8.7           gower_1.0.2             jomo_2.7-6             
 [73] tensor_1.5.1            minqa_1.2.8             plyr_1.8.9             
 [76] crayon_1.5.3            abind_1.4-8             orthopolynom_1.0-6.1   
 [79] sandwich_3.1-1          codetools_0.2-20        textshaping_1.0.4      
 [82] basefun_1.2-4           recipes_1.3.1           openssl_2.3.4          
 [85] bslib_0.9.0             GetoptLong_1.0.5        mime_0.13              
 [88] splines_4.4.3           Rcpp_1.1.0              fastDummies_1.7.5      
 [91] coneproj_1.20           variables_1.1-2         cellranger_1.1.0       
 [94] knitr_1.50              clue_0.3-66             lme4_1.1-38            
 [97] fs_1.6.6                listenv_0.10.0          checkmate_2.3.3        
[100] Rdpack_2.6.4            ggsignif_0.6.4          estimability_1.5.1     
[103] tzdb_0.5.0              pkgconfig_2.0.3         tools_4.4.3            
[106] cachem_1.1.0            rbibutils_2.4           numDeriv_2016.8-1.1    
[109] viridisLite_0.4.2       DBI_1.2.3               fastmap_1.2.0          
[112] rmarkdown_2.30          ica_1.0-3               tram_1.2-4             
[115] sass_0.4.10             officer_0.6.6           coda_0.19-4.1          
[118] dotCall64_1.2           RANN_2.6.2              rpart_4.1.24           
[121] farver_2.1.2            reformulas_0.4.2        mgcv_1.9-1             
[124] yaml_2.3.11             workflowr_1.7.2         foreign_0.8-88         
[127] cli_3.6.5               stats4_4.4.3            lifecycle_1.0.4        
[130] uwot_0.2.4              askpass_1.2.1           lava_1.8.0             
[133] backports_1.5.0         mlt_1.6-6               timechange_0.3.0       
[136] gtable_0.3.6            rjson_0.2.23            ggridges_0.5.7         
[139] progressr_0.18.0        parallel_4.4.3          jsonlite_2.0.0         
[142] RcppHNSW_0.6.0          mitml_0.4-5             qrng_0.0-10            
[145] spatstat.utils_3.2-0    zip_2.3.1               jquerylib_0.1.4        
[148] spatstat.univar_3.1-5   timeDate_4051.111       lazyeval_0.2.2         
[151] shiny_1.12.0            htmltools_0.5.9         sctransform_0.4.2      
[154] glue_1.8.0              gfonts_0.2.0            BB_2019.10-1           
[157] spam_2.11-1             gdtools_0.3.7           rprojroot_2.1.1        
[160] boot_1.3-31             igraph_2.2.1            R6_2.6.1               
[163] labeling_0.4.3          ipred_0.9-15            nloptr_2.2.1           
[166] tidyselect_1.2.1        vipor_0.4.7             plotrix_3.8-4          
[169] htmlTable_2.4.3         operator.tools_1.6.3    xml2_1.5.1             
[172] fontBitstreamVera_0.1.1 future_1.68.0           ModelMetrics_1.2.2.2   
[175] KernSmooth_2.23-26      S7_0.2.1                fontquiver_0.2.1       
[178] htmlwidgets_1.6.4       rlang_1.1.6             spatstat.sparse_3.1-0  
[181] spatstat.explore_3.6-0  uuid_1.2-1              formula.tools_1.7.1    
[184] hardhat_1.4.1           beeswarm_0.4.0          prodlim_2023.08.28     
date()
[1] "Fri Mar  6 09:02:35 2026"

sessionInfo()
R version 4.4.3 (2025-02-28)
Platform: aarch64-apple-darwin20
Running under: macOS 26.3

Matrix products: default
BLAS:   /Library/Frameworks/R.framework/Versions/4.4-arm64/Resources/lib/libRblas.0.dylib 
LAPACK: /Library/Frameworks/R.framework/Versions/4.4-arm64/Resources/lib/libRlapack.dylib;  LAPACK version 3.12.0

locale:
[1] en_US.UTF-8/en_US.UTF-8/en_US.UTF-8/C/en_US.UTF-8/en_US.UTF-8

time zone: Europe/Zurich
tzcode source: internal

attached base packages:
[1] grid      stats     graphics  grDevices utils     datasets  methods  
[8] base     

other attached packages:
 [1] ImmunoLogic_0.0.0.9000 Seurat_5.3.1           SeuratObject_5.2.0    
 [4] sp_2.2-0               kernlab_0.9-33         dbscan_1.2-0          
 [7] umap_0.2.10.0          Rtsne_0.17             cluster_2.1.8         
[10] factoextra_1.0.7       randomForest_4.7-1.2   pROC_1.19.0.1         
[13] mice_3.18.0            caret_7.0-1            lattice_0.22-6        
[16] drc_3.0-1              logistf_1.26.1         glmnet_4.1-10         
[19] Matrix_1.7-2           broom_1.0.11           MuMIn_1.48.11         
[22] Hmisc_5.2-3            car_3.1-3              carData_3.0-5         
[25] multcomp_1.4-28        TH.data_1.1-4          MASS_7.3-65           
[28] survival_3.8-3         mvtnorm_1.3-3          rstatix_0.7.3         
[31] ggpattern_1.2.1        gridExtra_2.3          cowplot_1.2.0         
[34] patchwork_1.3.2        plotly_4.11.0          EnhancedVolcano_1.24.0
[37] RColorBrewer_1.1-3     circlize_0.4.16        ComplexHeatmap_2.22.0 
[40] pheatmap_1.0.12        corrplot_0.95          ggcorrplot_0.1.4.1    
[43] ggbeeswarm_0.7.2       ggrepel_0.9.6          ggpubr_0.6.2          
[46] readxl_1.4.5           writexl_1.5.0          openxlsx_4.2.5.2      
[49] gtsummary_2.4.0        flextable_0.9.6        tableone_0.13.2       
[52] table1_1.4.3           scales_1.4.0           here_1.0.2            
[55] janitor_2.2.0          magrittr_2.0.4         data.table_1.17.8     
[58] lubridate_1.9.4        forcats_1.0.1          stringr_1.6.0         
[61] dplyr_1.1.4            purrr_1.2.0            readr_2.1.6           
[64] tidyr_1.3.1            tibble_3.3.0           ggplot2_4.0.1         
[67] tidyverse_2.0.0       

loaded via a namespace (and not attached):
  [1] IRanges_2.40.1          nnet_7.3-20             goftest_1.2-3          
  [4] vctrs_0.6.5             spatstat.random_3.4-3   digest_0.6.39          
  [7] png_0.1-8               shape_1.4.6.1           git2r_0.36.2           
 [10] alabama_2023.1.0        deldir_2.0-4            httpcode_0.3.0         
 [13] parallelly_1.45.1       fontLiberation_0.1.0    reshape2_1.4.5         
 [16] httpuv_1.6.16           foreach_1.5.2           BiocGenerics_0.52.0    
 [19] withr_3.0.2             xfun_0.54               crul_1.4.2             
 [22] emmeans_1.10.4          systemfonts_1.3.1       ragg_1.5.0             
 [25] zoo_1.8-14              GlobalOptions_0.1.3     gtools_3.9.5           
 [28] pbapply_1.7-4           Formula_1.2-5           promises_1.5.0         
 [31] otel_0.2.0              httr_1.4.7              globals_0.18.0         
 [34] fitdistrplus_1.2-4      rstudioapi_0.17.1       pan_1.9                
 [37] miniUI_0.1.2            generics_0.1.4          base64enc_0.1-3        
 [40] curl_7.0.0              S4Vectors_0.44.0        mitools_2.4            
 [43] polyclip_1.10-7         quadprog_1.5-8          xtable_1.8-4           
 [46] doParallel_1.0.17       evaluate_1.0.5          hms_1.1.4              
 [49] irlba_2.3.5.1           colorspace_2.1-2        polynom_1.4-1          
 [52] ROCR_1.0-11             reticulate_1.44.1       spatstat.data_3.1-9    
 [55] lmtest_0.9-40           snakecase_0.11.1        later_1.4.4            
 [58] spatstat.geom_3.6-1     future.apply_1.20.0     scattermore_1.2        
 [61] survey_4.4-2            matrixStats_1.5.0       RcppAnnoy_0.0.22       
 [64] class_7.3-23            pillar_1.11.1           nlme_3.1-167           
 [67] iterators_1.0.14        compiler_4.4.3          RSpectra_0.16-2        
 [70] stringi_1.8.7           gower_1.0.2             jomo_2.7-6             
 [73] tensor_1.5.1            minqa_1.2.8             plyr_1.8.9             
 [76] crayon_1.5.3            abind_1.4-8             orthopolynom_1.0-6.1   
 [79] sandwich_3.1-1          codetools_0.2-20        textshaping_1.0.4      
 [82] basefun_1.2-4           recipes_1.3.1           openssl_2.3.4          
 [85] bslib_0.9.0             GetoptLong_1.0.5        mime_0.13              
 [88] splines_4.4.3           Rcpp_1.1.0              fastDummies_1.7.5      
 [91] coneproj_1.20           variables_1.1-2         cellranger_1.1.0       
 [94] knitr_1.50              clue_0.3-66             lme4_1.1-38            
 [97] fs_1.6.6                listenv_0.10.0          checkmate_2.3.3        
[100] Rdpack_2.6.4            ggsignif_0.6.4          estimability_1.5.1     
[103] tzdb_0.5.0              pkgconfig_2.0.3         tools_4.4.3            
[106] cachem_1.1.0            rbibutils_2.4           numDeriv_2016.8-1.1    
[109] viridisLite_0.4.2       DBI_1.2.3               fastmap_1.2.0          
[112] rmarkdown_2.30          ica_1.0-3               tram_1.2-4             
[115] sass_0.4.10             officer_0.6.6           coda_0.19-4.1          
[118] dotCall64_1.2           RANN_2.6.2              rpart_4.1.24           
[121] farver_2.1.2            reformulas_0.4.2        mgcv_1.9-1             
[124] yaml_2.3.11             workflowr_1.7.2         foreign_0.8-88         
[127] cli_3.6.5               stats4_4.4.3            lifecycle_1.0.4        
[130] uwot_0.2.4              askpass_1.2.1           lava_1.8.0             
[133] backports_1.5.0         mlt_1.6-6               timechange_0.3.0       
[136] gtable_0.3.6            rjson_0.2.23            ggridges_0.5.7         
[139] progressr_0.18.0        parallel_4.4.3          jsonlite_2.0.0         
[142] RcppHNSW_0.6.0          mitml_0.4-5             qrng_0.0-10            
[145] spatstat.utils_3.2-0    zip_2.3.1               jquerylib_0.1.4        
[148] spatstat.univar_3.1-5   timeDate_4051.111       lazyeval_0.2.2         
[151] shiny_1.12.0            htmltools_0.5.9         sctransform_0.4.2      
[154] glue_1.8.0              gfonts_0.2.0            BB_2019.10-1           
[157] spam_2.11-1             gdtools_0.3.7           rprojroot_2.1.1        
[160] boot_1.3-31             igraph_2.2.1            R6_2.6.1               
[163] labeling_0.4.3          ipred_0.9-15            nloptr_2.2.1           
[166] tidyselect_1.2.1        vipor_0.4.7             plotrix_3.8-4          
[169] htmlTable_2.4.3         operator.tools_1.6.3    xml2_1.5.1             
[172] fontBitstreamVera_0.1.1 future_1.68.0           ModelMetrics_1.2.2.2   
[175] KernSmooth_2.23-26      S7_0.2.1                fontquiver_0.2.1       
[178] htmlwidgets_1.6.4       rlang_1.1.6             spatstat.sparse_3.1-0  
[181] spatstat.explore_3.6-0  uuid_1.2-1              formula.tools_1.7.1    
[184] hardhat_1.4.1           beeswarm_0.4.0          prodlim_2023.08.28