预测患有急性损伤的儿科患者的结果:使用机器学习模型进行回顾性单中心队列研究
Feifei Shen1, Ying Xu2, Xusheng Jiang3
1Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, China.
BMC medical informatics and decision making
|October 11, 2025
概括
机器学习模型准确地预测了急性损伤 (AKI) 严重疾病儿童的死亡率. 乳酸盐水平升高是关键预测因素,指导早期干预以获得更好的结果.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 医疗保健中的机器学习
- 腎臟醫學 腎臟醫學
背景情况:
- 急性损伤 (AKI) 是重症儿童的一个重大问题,与高死亡率有关.
- 准确预测死亡率对于及时干预和改善患者结果至关重要.
- 现有的预测模型可能无法完全利用先进的机器学习技术来处理复杂的儿科重症监护数据.
研究的目的:
- 开发和评估与生存分析集成的机器学习 (ML) 模型,用于预测患有AKI的儿科患者的7,14和28天死亡率.
- 确定死亡率的关键预测因素,以促进风险分层并指导早期治疗策略.
- 通过时间到事件分析,评估预测因素对死亡率的时间影响.
主要方法:
- 利用儿科重症监护 (PIC) 数据库,分析了来自AKI的3624名儿童 (2010-2018) 的数据.
- 训练了9个ML算法,包括CatBoost,用于死亡率预测;特征的重要性是使用SHapley添加式扩展 (SHAP) 来确定的.
- 进行了时间到事件分析 (Kaplan-Meier,限制立方线),以检查预测因素对28天死亡率的影响,按年龄和AKI阶段分层.
主要成果:
- CatBoost表现出优异的性能,曲线下面积 (AUC) 值高:0.871 (7天),0.871 (14天) 和0.867 (28天).
- 乳酸盐成为所有模型中最重要的预测因素.
- 事件发生前的时间分析显示,乳糖水平升高 (>1.5 mmol/L) 与28天死亡率 (p<0.001) 之间存在线性关联,特别是在婴儿和AKI第一阶段患者中.
结论:
- 机器学习,特别是CatBoost,与生存分析相结合,可准确预测AKI重症儿童的死亡率.
- 乳酸是风险分层的关键标志物,需要有针对性的早期干预措施.
- 这些发现支持精准医学方法,但为了广泛的临床实施,需要多中心验证.
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