预测术后败血症幸存者的早期再入院或出院后死亡率
Tyler Zander1, Melissa A Kendall1, Rachel L Wolansky1
1Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL; Department of Surgery, Moffitt Cancer Center, Tampa, FL.
Surgery
|July 16, 2025
概括
预测败血症幸存者的不良结果至关重要. 这项研究确定了影响术后14天再入院或术后败血症患者死亡率的关键术后因素,有助于风险分层.
科学领域:
- 手术成果研究的研究结果.
- 机器学习在医疗保健中的应用
- 关键护理医学 关键护理医学
背景情况:
- 败血症的幸存者面临着重入院和出院后死亡的重大风险.
- 手术后败血症和败血性休克的幸存者特别容易在出院后出现不良结果.
研究的目的:
- 预测手术后败血症或败血性休克的幸存者14天的意外再入院或14天的出院后死亡率.
- 确定与这些放弃后不良结果相关的有影响力的因素.
主要方法:
- 利用了国家外科质量改善计划数据库 (2018-2021).
- 使用轻度梯度增强机和极度梯度增强模型,有或没有合成少数群体过量采样技术,以预测结果.
- 应用夏普利添加剂解释用于模型解释.
主要成果:
- 该研究包括30971名患者,其中13.4%的患者经历了出院后的不良结果.
- 在没有过量采样的情况下, eXtreme渐变增强实现了最高的预测性能 (AUC 0.65).
- 关键预测因素包括死亡/发病概率,出院的几天,手术时的败血症,白细胞计数,工作相对值单位,ASA类,手术时间和免疫抑制.
结论:
- 在术后败血症幸存者中确定了治疗后不良结果的独特外科预测因子.
- 尽管对阶级不平衡有先进的技术,但预测性表现还是温和的.
- 未来的模型需要额外的预测因子来实现更全面的患者代表性.
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