走向瘤学中的主动息护理:开发一种可解释的基于电子健康记录的机器学习模型,用于死亡风险预测
Qingyuan Zhuang1,2, Alwin Yaoxian Zhang3, Ryan Shea Tan Ying Cong4,5
1Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore. zhuang.qingyuan@singhealth.com.sg.
BMC palliative care
|May 20, 2024
概括
这项研究开发了一种可解释的机器学习模型,使用电子健康记录来预测晚期癌症患者的365天死亡风险,促进主动息护理. 该模型在识别需要支持性护理的患者方面表现强.
科学领域:
- 在瘤学瘤学.
- 医疗信息学 医疗信息学
- 机器学习 机器学习
背景情况:
- 早期识别生命终点对于积极的息护理至关重要.
- 使用电子健康记录 (EHR) 的机器学习 (ML) 模型显示出癌症预后的前景.
- 现有的模型往往缺乏性能透明度,临床一致性和可解释性,阻碍了采用.
研究的目的:
- 使用EHR数据开发一种可解释的ML模型,以预测晚期癌症患者的365天死亡风险.
- 促进缓和护理服务在门诊机构的早期整合.
- 通过模型透明度和可解释性来增强临床信任和采用.
主要方法:
- 分析了一组5926名晚期癌症患者 (3-4期固体器官) 的队列.
- 使用极端梯度提升 (XGBoost) 来从门诊EHR数据中预测365天死亡率.
- 对于模型的可解释性,使用了沙普利增量解释 (SHAP),性能通过AUROC,AUPRC和Brier分数进行评估.
主要成果:
- 该模型实现了0.861的接收器操作特征曲线 (AUROC) 下的面积和0.771.771的精度召回曲线 (AUPRC) 下的面积.
- 布里尔评分为0.147表示死亡风险略高估计.
- SHAP值提供了全球和个别特征影响可视化.
结论:
- 开发的ML模型有效预测晚期癌症患者的365天死亡率.
- 该模型表现出强烈的歧视和精确回忆,支持个性化预测.
- 这种工具可以帮助更早地整合息治疗,改善患者的治疗结果.
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