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多中心向试验模拟评估皮质类固醇对于预测器官功能障碍轨迹分层的败血症

Suraj Rajendran¹, Zhenxing Xu², Weishen Pan²

¹Tri-Institutional Computational Biology & Medicine Program, Cornell University, Cornell, NY, USA.

Nature communications

|May 13, 2025

概括

皮质类固醇在诸如败血症和ARDS等严重疾病中的有效性取决于患者的病历. 根据个体疾病路径量身定制治疗方法可以改善结果并降低死亡率.

科学领域:

关键护理医学关键护理医学
传染性疾病传染性疾病
药理学药理学是指药理学的学科.

背景情况:

皮质类固醇用于败血症,败血性休克,肺炎和ARDS.
皮质类固醇的确切风险效益平衡,特别是关于器官功能障碍的持续时间,仍然不清楚.
现有的研究缺乏对皮质类固醇使用如何影响不同患者轨迹的死亡率的细微了解.

研究的目的:

评估皮质类固醇使用与毒症,肺炎和ARDS患者28天死亡率之间的关联.
根据预测的器官功能障碍轨迹对患者进行分层.
模拟一个目标试验框架来分析治疗效果.

主要方法:

追溯性,多中心,概念验证研究.
两阶段机器学习方法用于患者亚表型和轨迹预测.
在患者分类后应用的目标试验仿真框架.

主要成果:

皮质类固醇使用与28天死亡率之间的关联根据预测的器官功能障碍轨迹有显著的变化.
不同的患者队列对皮质类固醇治疗表现出不同的反应.
机器学习成功地根据器官功能障碍的进展对患者进行了分类.

结论:

在严重疾病中皮质类固醇的效用取决于轨迹.
将皮质类固醇治疗策略与经验观察到的病理生物学相匹配,提供了一个更细致的方法.
个性化医疗策略可以优化在败血症,肺炎和ARDS中使用皮质类固醇.

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