通过战略数据归算和可解释的机器学习预测术后感染
Hugo Guillen-Ramirez1, Daniel Sanchez-Taltavull1, Stéphanie Perrodin1
1Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland.
Journal of the American Medical Informatics Association : JAMIA
|August 31, 2025
概括
将动态术后实验室值整合到机器学习模型中可以显著改善手术后的细菌感染检测. 这种方法提供了比传统方法更及时,更准确的预测,有助于临床决策.
科学领域:
- 医疗信息学
- 在医疗保健中的机器学习
- 手术成果研究
背景情况:
- 医疗相关感染是患者发病和死亡的主要原因.
- 早期检测术后感染对于有效的患者治疗至关重要.
- 传统的手术预测模型主要依赖于手术前的数据.
研究的目的:
- 评估整合术后实验室值及其动力学预测细菌感染的有效性.
- 开发和评估包含动态实验室数据的过程无关预测模型.
- 将动态模型的性能与静态模型或仅用于手术前的模型进行比较.
主要方法:
- 从电子健康记录 (EHR) 中分析了91,794例手术病例.
- 使用手术前,手术内和手术后变量开发机器学习模型.
- 纳入实验室值的静态和运动性质,并对缺少的数据进行战略归算.
主要成果:
- 机器学习模型整合实验室动力学,在术后第二天实现回忆,精度和ROC AUC分别为0. 71,0. 69和0. 83.
- 使用动态模型检测感染的效果优于基于临床医生的决策.
- 从肝脏,脏和骨髓功能标记物中确定新的预测组合.
结论:
- 术后实验室值的动态建模提高了感染检测的及时性和准确性.
- 可解释的机器学习有助于临床解释,并强调多器官系统参与感染风险.
- 开发的工作流程与手术无关,可通用,并有可能优化患者的治疗结果和资源利用.
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