使用因果生存网与血清化物和其他因果因素预测重症监护室患者的住院死亡率:跨国研究
Jing Wang1, Qixiu Li1, Can Xie2
1Department of Critical Care Medicine, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
Journal of medical Internet research
|July 24, 2025
概括
最初的血清化物水平对于预测重症监护室 (ICU) 患者死亡率至关重要. 偏离103-115mEq/L范围显著增加死亡风险,有助于个性化治疗策略.
科学领域:
- 临界护理医学 临界护理医学
- 临床化学 临床化学
- 生物统计学 生物统计学
- 在医疗保健中的数据科学.
背景情况:
- 血清化物水平是重症监护室 (ICU) 中潜在的预后指标.
- 利用化物水平可以完善风险分层和治疗,改善患者的治疗结果和资源配置.
研究的目的:
- 量化分析了重症监护室 (ICU) 入院时血清化物水平与住院死亡率之间的关联.
- 开发个性化的生存曲线预测深度学习模型,以提高风险分层和临床决策.
主要方法:
- 一项大规模的多队列研究,涉及189,462名来自美国和中国数据库 (MIMIC-IV,eICU-CRD,Yantai Yuhuangding医院,Zigong第四人民医院) 的ICU患者.
- 使用因果图分析,受限立方线,考克斯比例危险模型,考克斯脆弱模型,卡普兰-梅尔曲线和灵敏度分析来评估关联.
- 一个深度学习模型 (Causal SurvivalNet) 已被开发用于个性化的生存预测.
主要成果:
- 摄入血清化物水平与28天死亡率有显著的相关性,临界值为103mEq/L和115mEq/L.
- 化物含量≤103mEq/L (HR 1.36) 和>115mEq/L (HR 1.27) 的患者表现出更高的死亡风险.
- 跨队列验证证实了这些范围,因果生存网络模型证明了准确的个人生存预测 (布赖尔得分为0.09-0.15).
结论:
- 最初的血清化物水平对于提高ICU患者的预后准确性是有价值的.
- 这些发现支持根据化物水平为重症监护机构制定量身定制的治疗计划.
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