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在第一波COVID-19患者开发的无监督集群模型在第二/第三波危急病患者中的适用性
Alejandro Rodríguez1, Josep Gómez2, Álvaro Franquet2
1Critical Care Department - Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Universidad Rovira & Virgili/Institut d'Investigació Sanitaria Pere Virigili/CIBERES, Tarragona, Spain.
Medicina intensiva
|March 10, 2024
概括
针对COVID-19患者表型的机器学习模型需要在不同的流行浪潮中进行验证. 在大流行早期开发的无监督集群模型在后来的波浪中表现不佳,需要新的波浪特定模型.
科学领域:
- 关键护理医学 关键护理医学
- 在医疗保健中的数据科学.
- 流行病学 流行病学
背景情况:
- 机器学习模型,包括无监督集群模型 (USCM),是在COVID-19流行病的第一波期间开发的,用于分类重症患者.
- 这些模型在随后的流行病浪潮中的有效性,其特点是潜在的不同患者人口统计和疾病表现,仍需得到验证.
研究的目的:
- 为了验证在第一个COVID-19大流行浪潮期间开发的现有USCM.
- 评估USCM在第二次和第三次大流行浪潮中的重症患者队列中的表现.
- 如果原始模型的性能不充分,则开发和验证针对验证队列的新USCM.
主要方法:
- 在第二次和第三次大流行浪潮期间,对在重症监护室 (ICU) 接受COVID-19和呼吸衰竭的成年患者进行了一项回顾性多中心观察研究.
- 收集了人口,临床,并发症,实验室和ICU结局数据.
- 原始的USCM被应用到验证队列中,其性能使用轮系数 (SC) 和一般线性建模来评估.
- 一个后期的USCM被开发和验证,使用准确度和接受器操作特征 (ROC) 曲线的曲线下的面积 (AUC).
主要成果:
- 总共有2330名患者被纳入,ICU死亡率为27.2%.
- 最初的USCM将患者分为三个表型 (A,B,C),但它的表现很差 (SC = -0.007),它没有改善回归模型的表现.
- 与原始模型相比,为验证集开发的后期USCM显示出更好的性能 (SC = -0.08).
结论:
- 在第一个COVID-19大流行浪潮期间开发的机器学习模型可能无法在随后的浪潮中对入院的患者保持足够的性能.
- 在将模型应用于不同流行病阶段之前,事先验证至关重要.
- 开发特定波浪模型可能是必要的,以确保在不断变化的流行病学背景下准确的患者表型和分类.
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