开发和验证可解释的机器学习模型,用于预测PD-1/PD-L1治疗患者的AKI风险:一项回顾性研究
Wentong Liu1,2, Kaiyue Ji1, Qianwen Tang3
1Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.
BMC medical informatics and decision making
|August 9, 2025
概括
这项研究开发了一种可解释的机器学习模型,用于预测接受抗编程细胞死亡蛋白1 (PD-1) /编程细胞死亡连接体1 (PD-L1) 免疫治疗的患者的急性损伤 (AKI). 该模型有助于早期识别高风险患者以进行个性化治疗.
科学领域:
- 在瘤学瘤学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫治疗是一种免疫疗法.
- 机器学习 机器学习
背景情况:
- 反编程细胞死亡蛋白1 (PD-1) /编程细胞死亡联体1 (PD-L1) 免疫疗法已经改变了癌症治疗,但可能导致急性损伤 (AKI).
- 早期的AKI预测对于管理治疗中断和改善患者结果至关重要.
- 现有的研究缺乏针对服用PD-1/PD-L1抑制剂的患者强大的AKI风险预测模型.
研究的目的:
- 开发和验证可解释的机器学习 (ML) 模型,用于早期AKI预测.
- 在PD-1/PD-L1抑制剂治疗期间识别患有AKI高风险的患者.
- 促进个性化治疗策略,改善患者的预后.
主要方法:
- 回顾性队列设计利用从2018年1月到2024年1月的数据.
- 评估了9个ML模型,其中选择了梯度增强机 (GBM) 以获得最佳性能.
- 应用夏普利添加式解释 (SHAP) 来确定特征重要性和模型可解释性.
主要成果:
- GBM模型表现出强大的预测性能,验证组的AUC为0.850,测试组的AUC为0.795.
- 校准曲线证实了预测和观察到的AKI风险之间的良好一致性.
- 开发了一种具有13个特征的可解释的GBM模型,并提供基于Web的计算器供临床使用.
结论:
- 一个可解释的ML模型已成功开发和验证,用于预测接受PD-1/PD-L1抑制剂的患者的AKI.
- 该模型能够早期识别高风险个体,支持个性化治疗调整.
- 这种工具可以帮助临床医生在癌症免疫治疗环境中主动管理AKI.
更多相关视频
相关概念视频
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
57
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...
57
01:22Acute Kidney Injury I: Introduction
74
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...
74
01:20Acute Kidney Injury V: Interprofessional Care
44
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...
44
01:22Acute Kidney Injury VI: Nursing Management
58
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...
58
01:29Acute Kidney Injury II: Pathophysiology
73
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...
73
01:28Chronic Kidney Disease III: Interprofessional Care
80
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
80