对毒症实时预测模型的验证和性能进行了一项方法学系统性审查
Zichen Wang1,2,3,4, Wen Wang5,6,7, Che Sun1,2,3
1Department of Critical Care Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
NPJ digital medicine
|April 6, 2025
概括
实时败血症预测模型在现实世界的验证中显示效率降低. 综合测试对于临床采用这些败血症预测模型至关重要.
科学领域:
- 医疗信息学 医疗信息学
- 临床预测模型临床预测模型
- 败血症研究 败血症研究
背景情况:
- 败血症实时预测模型 (SRPMs) 提供了早期预警和改善患者结果的潜力.
- 临床采用有限的原因是SRPM中的不一致的验证和潜在偏差.
- 强有力的评估,包括外部全窗口验证,是必不可少的,但证据很少.
研究的目的:
- 通过各种验证方法系统地审查SRPM的性能.
- 分析不同验证方法对SRPM有效性的影响.
- 确定影响SRPM性能的因素,并指导未来的发展.
主要方法:
- 来自多个数据库的91项研究的系统文献综述.
- 在各种验证条件下分析SRPM性能指标 (内部,外部,全窗口).
- 评估模型和结果层面的指标,包括AUROC和实用分数.
主要成果:
- 只有54.9%的研究使用了两种度量类型的全窗口验证.
- 在外部和全窗口验证场景中,性能显著下降.
- 中位数AUROC从0.886 (内部) 降至0.783 (全窗口外部验证).
- 中位数实用性得分从0.381 (内部) 降至-0.164 (外部验证).
- 手工制作的功能对SRPM性能产生了显著的积极影响.
结论:
- 目前对SRPM的验证实践往往不足以实现现实世界的部署.
- 外部和全窗口验证显示性能低于内部评估.
- 未来的SRPM研究需要多中心数据,强大的验证,以及临床实施的前性试验.
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