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评估常见临床混因素对基于深度学习的败血症风险评估绩效的影响
Shikha Chaganti1, Vivek Singh1, Alasdair Edward Gent2
1Siemens Healthineers, Princeton, NJ, United States.
Frontiers in artificial intelligence
|July 30, 2025
概括
这项研究开发了一种深度学习模型,用于在24小时内使用常规血液检测来早期检测败血症. 结合两种败血症定义的共识方法实现了83.7%的敏感性和80%的特异性,突出了伴随性疾病的挑战.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健中的机器学习
- 临床决策支持系统 临床决策支持系统
背景情况:
- 由于诊断的模糊性和患者表现的多样性,在急诊室中早期识别败血症是困难的.
- 现有的机器学习模型面临着数据标记和混并发症的挑战.
研究的目的:
- 开发和评估一种深度学习模型,用于在入院前24小时内使用常规临床数据来早期检测败血症.
- 通过探索Sepsis-3和成人败血症事件定义以及基于共识的方法来解决标签不确定性.
- 评估不同患者队伍的模型性能,包括患有并发症和确诊感染的患者.
主要方法:
- 一个深度学习模型被训练在常规血液检测结果 (CBC,CMP,脂质面板),生命体征,年龄和性别.
- 两种败血症定义 (败血症-3,成人败血症事件) 用于创建基础真相标签,并评估了一种共识方法.
- 分析了各种患者子组的模型性能,包括患有慢性病,肝病,凝血障碍和确诊感染的患者.
主要成果:
- 基于共识的模型实现了83.7%的灵敏度,80%的特异性,36%的正预测值 (PPV),97%的负预测值 (NPV) 和0.9.9的AUC.
- 在感染确定的子组中观察到高PPV的77%.
- 在具有混杂并发症的队列中,特异性下降,从47%到70%不等.
结论:
- 追溯性败血症定义对自动检测系统存在局限性.
- 需要量身定制的方法来准确检测患有混杂并发症的患者的败血症.
- 基于共识的深度学习模型对早期败血症风险识别有希望,但需要仔细考虑患者异质性.
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