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重构患者分层,以针对性干预措施,考虑疾病发病导致的下游结果的严重程度:败血症的案例研究
Fahad Kamran1, Donna Tjandra1, Thomas S Valley2,3
1Division of Computer Science and Engineering, Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, United States.
概括
根据败血症风险和结局严重程度对患者进行分层,可以识别出不同的人,而不是仅仅是风险. 这种方法可以通过考虑疾病的全部影响来优化干预措施.
科学领域:
- 临床信息学 临床信息学
- 在医疗保健中的预测建模.
- 患者的分层是患者的分层.
背景情况:
- 准确的患者分层对于有针对性的医疗干预至关重要.
- 目前的预测模型往往只关注疾病发病风险.
- 疾病对下游结果的影响在分层策略中经常被忽视.
研究的目的:
- 以基于预测疾病发病风险的患者分层进行比较,与将风险和下游结果严重性纳入的分层进行比较.
- 通过这两种分层方法检测出患者群体的差异.
- 将这些方法应用于败血症预测的案例研究.
主要方法:
- 来自两个主要医疗中心 (密歇根医学和伯特以色列迪康尼斯医疗中心) 的观察数据的回顾分析.
- 估计的败血症风险与其对死亡率的影响之间的斯皮尔曼相关性计算.
- 通过单独风险对风险和死亡影响进行分层的患者队列的比较.
主要成果:
- 败血症风险及其对死亡率的影响显示出弱相关性 (U-M:0.35,BIDMC:0.31).
- 高风险患者的方法重叠是中度的 (66.8%的U-M,52.8%的BIDMC).
- 根据死亡率影响的分层确定了老年患者群体.
结论:
- 干预预措施的预测模型应纳入疾病对下游结果的影响.
- 根据风险和结果严重程度对患者进行分层,与仅基于风险的分层相比,可以识别出一个独特的人群.
- 忽视下游效应的模型可能不足以指导选择性干预.
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