开发和外部验证多模式术后急性损伤风险机器学习模型
George K Karway1, Jay L Koyner2, John Caskey1
1Department of Medicine, University of Wisconsin-Madison, Madison, WI 53792, United States.
JAMIA open
|December 25, 2023
概括
预测术后急性损伤 (AKI) 的机器学习模型通过将结构化电子健康记录数据与非结构化临床笔记相结合而得到改善. 这种多模式的方法增强了AKI检测和患者护理.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健中的机器学习
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 手术后急性损伤 (AKI) 是一个重要的并发症.
- 准确预测AKI对于及时干预至关重要.
- 电子健康记录 (EHR) 包含用于预测建模的宝贵数据.
研究的目的:
- 开发和验证机器学习模型,用于预测术后的AKI.
- 评估结构化和非结构化EHR数据的实用性.
- 为了比较不同的机器学习算法和数据集成策略.
主要方法:
- 使用结构化EHR数据 (人口统计,生命体征,实验室) 和非结构化临床笔记.
- 从临床笔记中提取概念独特标识符 (CUI),使用临床文本分析和知识提取系统.
- 开发了使用极端梯度增强机 (XGBoost) 和弹性净物流回归 (GLMNET) 的单模 (仅结构化) 和多模 (结构化+CUI) 模型.
- 外部验证模型使用来自两个学术医疗中心的数据.
主要成果:
- 该研究包括138,389名成年术后入院患者,其中2.1%的人患有2期或更高的AKI.
- 在XGBoost模型中,通常表现优于GLMNET.
- 多式联网XGBoost模型采用CUI加权的术语频率-反向文档频率 (TF-IDF) 实现了最高的预测性能 (AUROC 0.82).
结论:
- 综合结构化EHR数据与来自非结构化笔记的CUI的多模式方法显著改善了术后AKI的预测模型性能.
- 这一策略增强了AKI的检测,可能导致更好的患者结果.
- 概念独特标识符 (CUI) 是强大的预测器,当与临床预测模型中的结构化数据相结合时.
相关概念视频
01:22Acute Kidney Injury I: Introduction
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
01:29Acute Kidney Injury II: Pathophysiology
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
01:29Acute Kidney Injury III: Clinical Manifestations
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...