利用手术期间的呼吸系统动态特征来开发和验证术后肺部并发症的可解释机器学习模型.
Peiyi Li1, Shuanliang Gao2, Yaqiang Wang3
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
机器学习模型使用手术内数据准确预测术后肺部并发症 (PPC). 这使得个性化通风策略能够减少手术患者的肺损伤.
科学领域:
- 麻醉学和外科手术期间的医学.
- 人工智能在医学中的应用
- 肺部医学 肺部医学
背景情况:
- 手术后的肺部并发症 (PPC) 是老年手术患者的一个重大问题.
- 早期识别可修改的风险因素对于优化通风策略和减轻肺损伤至关重要.
研究的目的:
- 开发,验证和内部测试用于预测PPC的机器学习 (ML) 模型.
- 为了提高预测准确度,利用手术内呼吸系统特征.
主要方法:
- 对10284名接受10484次手术的患者 (65岁以上) 的术后数据进行分析.
- 对线性和非线性ML模型与ARISCAT工具的开发和比较.
- 应用沙普利添加式解释 (SHAP) 来解释特征重要性.
主要成果:
- 一个优化的XGBoost模型在验证中实现了0.878的AUROC,在潜在队列中达到0.881,显著超过ARISCAT (0.496-0.533).
- 确定的主要可修改预测因素包括呼吸系统动态系统的遵守,机械功率和驱动压力.
- 一个简化的20变量XGBoost模型产生了0.864的AUROC,并已被开发成一个Web工具.
结论:
- 使用ML模型,可以实时预测手术患者的PPC风险.
- 以这些模型为指导的个性化手术内呼吸器策略可能会减少PPCs.
- 开发的基于网络的工具需要进一步的外部验证.
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