预测重症监护室急性损伤的人工智能模型:对建模方法,数据利用和临床适用性的系统审查
Tongyue Shi1,2,3, Yu Lin4, Huiying Zhao5
1National Institute of Health Data Science, Peking University, Beijing 100191, China.
JAMIA open
|July 7, 2025
概括
使用人工智能在重症监护室 (ICU) 预测急性损伤 (AKI) 是有前途的,但模型需要更好的外部验证和临床使用的动态能力.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健中的人工智能
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 急性损伤 (AKI) 是重症监护室 (ICU) 患者的重大并发症,导致高死亡率和医疗费用增加.
- 早期预测AKI对于及时干预和改善患者结果至关重要.
- 现有的预测模型,包括机器学习和深度学习,需要对其方法和临床适用性进行进一步评估.
研究的目的:
- 在ICU中全面审查和评估AKI预测模型的建模方法,数据利用和临床适用性.
- 确定这些模型的开发和实施当前的挑战和局限性.
- 提出未来的研究方向,以提高重症监护机构的AKI预测.
主要方法:
- 在主要的科学数据库 (PubMed,Embase,Scopus,Web of Science,IEEE Xplore,ACM数字图书馆) 进行了系统的文献搜索,截至2024年12月12日.
- 包括报告AKI预测模型的研究,使用至少两个预测因素和绩效评估的ICU数据.
- 在包括的研究中评估了偏差风险 (PROBAST) 和报告质量 (TRIPOD).
主要成果:
- 在1305个选的研究中,有47个符合纳入标准,利用从机器学习到深度学习的各种AI技术.
- 外部验证仅在14项研究中进行,在44项研究中发现了偏差的高风险,特别是在概括性和临床适用性方面.
- 研究设计,预测窗口和数据源的显著异质性使模型比较复杂化.
结论:
- 人工智能模型显示了在ICU中AKI预测的潜力,但面临的挑战包括有限的外部验证,缺乏动态建模和糟糕的解释性.
- 解决这些局限性对于弥合模型开发和临床实践之间的差距至关重要.
- 未来的研究应该专注于开发动态,可解释和外部验证的模型,以提高AI在AKI预测中的现实应用性.
相关概念视频
01:22Acute Kidney Injury I: Introduction
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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
80
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
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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...
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01:20Acute Kidney Injury V: Interprofessional Care
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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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01:29Acute Kidney Injury II: Pathophysiology
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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
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01:22Acute Kidney Injury VI: Nursing Management
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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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01:29Acute Kidney Injury III: Clinical Manifestations
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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...
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