基于机器学习的预后模型的开发和验证,用于IgA脏病与慢性脏病阶段3或4的IgA脏病
Zixian Yu1, Xiaoxuan Ning2, Yunlong Qin1,3
1Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Kidney diseases (Basel, Switzerland)
|December 12, 2024
概括
这项研究开发了一种随机生存森林 (RSF) 模型,用于预测免疫球蛋白A脏病 (IgAN) 患者的末期脏病 (ESKD). 该RSF模型在识别病进展高风险患者方面表现出卓越的性能.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
- 生物统计学 生物统计学
背景情况:
- 免疫球蛋白A脏病 (IgAN) 患者的估计膜过率 (eGFR) 降低和蛋白尿升高,面临末期病 (ESKD) 的风险更高.
- 患有慢性病 (CKD) 3-4期和蛋白尿 ≥1.0 g/d的Igan患者的预后尚不清楚,需要准确的预测模型.
研究的目的:
- 开发和验证预后模型来预测ESKD和Igan患者的死亡率,这些患者患有CKD第3-4期和显著的蛋白尿.
- 确定影响该患者群体疾病进展的关键临床和病理因素.
主要方法:
- 利用了来自西京医院 (2008年12月至2020年1月) 263名Igan患者 (CKD3-4期,蛋白尿≥1.0g/d) 的数据.
- 开发并比较了包括随机生存森林 (RSF),生存支持矢量机器 (SSVM),极端梯度增强 (XGBoost) 和考克斯回归在内的预后模型.
- 使用一致性指数 (C-指数),集成的Brier分数 (IBS),净重新分类指数 (NRI) 和集成的歧视改进 (IDI) 评估模型性能.
主要成果:
- RSF模型实现了最高的预测准确性,在训练队列中C指数为0.871,在测试队列中为0.810.
- 确定了IGAN进展的七个显著风险因素:年龄,血液尿素,血清尿酸,血清,血清,淋巴结核硬化比率,血红蛋白和管状缩/间歇性纤维化.
- 与SSVM,XGBoost和Cox回归模型相比,RSF模型显示出优越的歧视和风险分类,正如NRI和IDI所指出的那样.
结论:
- 开发的RSF模型有效地预测了Igan患者的预后,这些患者患有CKD阶段3-4和蛋白尿≥1.0g/d.
- 该模型结合了七个关键的风险因素,为临床决策和患者管理提供了宝贵的见解.
- 该RSF模型显示了优越的性能比传统的方法,如Cox回归预测Igan进展.
相关概念视频
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
342
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
342
01:29Acute Kidney Injury III: Clinical Manifestations
1.8K
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...
1.8K
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
582
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...
582
01:25Chronic Kidney Disease I: Introduction
1.4K
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
1.4K
01:28Chronic Kidney Disease III: Interprofessional Care
706
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
706
01:18Chronic Kidney Disease IV: Nursing Management
702
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
702