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现型共识聚类和治疗异质性分析在患有并发性2型糖尿病的重症患者中
Xiujuan Chen1, Jiaqi Sun2, Huixian Li1
1Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
患有2型糖尿病 (CIP T2DM) 的重症患者被分为三个不同的亚型,揭示了临床特征和结果的显著差异. 针对这些CIP T2DM亚型的个性化干预可以改善患者的护理.
科学领域:
- 关键护理医学 关键护理医学
- 内分泌学 在内分泌学.
- 在医疗保健中的数据科学.
背景情况:
- 患有并发性2型糖尿病 (CIP T2DM) 的重症患者代表了一个复杂而异质的人群.
- 了解这个群体内的不同临床表型对于优化治疗策略和改善患者治疗结果至关重要.
研究的目的:
- 为CIP T2DM建立一个表型聚类模型.
- 根据全面的临床数据来定义不同的患者亚型.
- 分析已识别的亚型之间的临床特征,治疗反应和预后差异.
主要方法:
- 利用密集护理IV (MIMIC-IV) 数据库的医疗信息商城进行使用人口统计,生理和生化参数的表型化,以及危急疾病得分.
- 采用共识聚类算法来识别患者亚型.
- 使用eICU协作研究数据库 (eICU) 验证的亚型一致性.
- 提取了高频组合药物方案,以评估治疗异质性.
主要成果:
- 在MIMIC-IV队列 (n=6349) 中确定了三种不同的CIP T2DM亚型,在eICU队列 (n=1425) 中具有很高的一致性.
- 第1亚型 (CIP T2DM-SI - 严重感染) 的死亡率为16.7%,药物后血糖为8.25 mmol/L.
- 亚型2 (CIP T2DM-OF - 器官衰竭) 的死亡率为18.6%,药物后血糖为8.03 mmol/L.
- 第3亚型 (CIP T2DM-UM - 在监测中) 的死亡率为8.87%,药物后血糖为6.98 mmol/L.
- 在亚型中观察到不同的住院死亡风险,即使在相同的药物治疗方案中.
结论:
- 该研究成功地在CIP T2DM群体中确定了三种异构的表型.
- 这些表型在临床表现和预后方面表现出显著的差异.
- 针对这些特定的CIP T2DM亚型量身定制的个性化治疗策略有望减少不良事件并指导精确的临床管理.
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