可解释的机器学习框架,用于动态监测疾病预后风险:回顾性队列研究
Tetsuo Ishikawa1,2,3,4,5,6, Masahiro Shinoda4, Megumi Oya1,3,4,6
1Predictive Medicine Special Project, RIKEN Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, 230-0045, Japan, 81 45-503-7000.
JMIR formative research
|October 14, 2025
概括
这项研究为COVID-19患者开发了一个动态风险评估框架,改善了在住院期间早期检测死亡风险. 可解释模型提供及时,可解释的警告,以支持临床干预和资源分配.
科学领域:
- 医疗信息学 医疗信息学
- 临床预测模型临床预测模型
- 公共卫生 公共卫生
背景情况:
- 静态风险得分对于COVID-19等快速演变的患者疾病是不够的.
- 在COVID-19中异质的疾病轨迹需要动态的预后工具.
- 及时干预至关重要,正如COVID-19各种并发症死亡率所强调的那样.
研究的目的:
- 提出一个动态的预后风险评估框架,使用COVID-19的纵向住院数据.
- 开发一个可解释的模型,用于初始预后查和持续的死亡风险更新.
- 为临床医生提供早期,可解释的警告,以尽量减少认知负载和支持干预.
主要方法:
- 对382名COVID-19患者的电子医疗记录进行了回顾性分析.
- 梯度提升决策树 (轻梯度提升机) 用于初始风险预测.
- 随机生存森林 (RSF) 用于使用纵向数据进行动态每日死亡风险评估.
- SurvSHAP ((t) 用于对风险因素的时间依赖解释.
主要成果:
- 最初的预测模型与严重性结果有很好的一致性 (AUC高达0.970死亡).
- 动态RSF模型实现了高精度 (C指数为0.941,平均AUC为0.936).
- 动态评估在不良结果出现前1-2周确定了高风险患者,其中主要预测因子 (CRP,SpO2,血小板,β-D-葡萄糖) 正在变化.
结论:
- 整合静态和动态预测可以提前识别高风险的COVID-19患者.
- 该框架支持通过特定阶段的预测指标及时干预和高效的资源分配.
- 需要进行前性的多中心验证,以确认可概括性和临床影响.
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