在肠道阻塞手术后预测败血症的模型性能评估:一个多中心的回顾性研究
Chaojin Chen1,2, Jirong Yang1, Lei Zhang3
1Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Annals of medicine
|November 5, 2025
概括
我们开发了一种机器学习模型,用于预测肠道阻塞手术后的败血症. 该模型识别了高风险患者,有助于临床决策,并改善了这种高风险手术的结果.
科学领域:
- 手术瘤学手术瘤学
- 机器学习在医学中的应用
- 关键护理医学 关键护理医学
背景情况:
- 肠道阻塞手术具有显著的术后败血症风险.
- 早期预测败血症对于及时干预和改善患者结果至关重要.
研究的目的:
- 开发和验证一种机器学习模型,用于预测肠道阻塞手术后的败血症.
- 确定导致败血症发展的关键因素,用于临床决策支持.
主要方法:
- 一项多中心的回顾性研究,利用了2013-2021年的患者数据和INSPIRE数据集.
- 评估各种机器学习算法,包括支持矢量分类 (SVC).
- 模型性能使用接收器操作特征曲线下的面积 (AUC) 和夏普利添加式解释 (SHAP) 来评估可解释性.
主要成果:
- 在内部验证中,SVC模型取得了0.876的AUC,并在外部验证集中表现出强的表现 (AUC从0.873到0.896不等).
- 确定的主要预测特征包括患者年龄,POSSUM生理学得分,ASA分类,冲击指数,手术内液体体积和furosemide剂量.
- 在整个数据集中,术后败血症发生在12.7%至20%的患者中.
结论:
- 基于SVC模型开发了一个高度互操作的败血症风险计算器.
- 这种工具可以帮助接受肠道阻塞手术的患者在术后临床决策.
- 该模型通过SHAP值的可解释性提供了对毒症驱动因素的见解.
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