长期和慢性严重疾病中败血症预测的机器学习模型:使用回顾性真实世界ICU数据的开发和验证
Mikhail Ya Yadgarov1, Olga Yu Rebrova2, Levan B Berikashvili1
1Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia.
Journal of clinical medicine
|January 28, 2026
概括
在长期或慢性严重疾病 (PCI/CCI) 中预测败血症的机器学习模型显示出强大的内在性能,用于败血症排除,但缺乏通用性. 需要进一步的研究,以便在不同ICU人群中临床应用.
科学领域:
- 临界护理医学 临界护理医学
- 医疗保健中的机器学习
- 败血症预测预测的方法
背景情况:
- 现有的用于败血症预测的机器学习 (ML) 模型并不是专门为患有长期或慢性重症病 (PCI/CCI) 的患者设计的.
- 这种差距凸显了需要专门的ML工具来准确预测这种脆弱患者群体的败血症.
研究的目的:
- 为PCI/CCI患者量身定制的基于机器学习的败血症预测模型开发和验证.
- 评估PCI/CCI专注模型与在混合ICU人群上训练的通用模型之间的通用性.
主要方法:
- 从PCI/CCI患者的俄罗斯重症监护数据集 (RICD) 和急性危急疾病的公共PhysioNet数据集分析ICU入院情况.
- 使用基于树的算法 (XGBoost,LightGBM,Random Forest,AdaBoost) 在具有6小时窗口的右排预测框架内开发ML模型.
- 内部和外部验证,包括对败血症表型的子组分析和PCI/CCI专注和通用模型的比较.
主要成果:
- 专注于PCI/CCI的XGBoost模型在内部实现了0.82的AUROC,但在外部验证中失败了 (AUROC 0.47).
- 一个通用模型显示PCI/CCI患者的歧视减少 (AUROC平均差异为0.02,p=0.0012).
- 关键预测因素包括呼吸速率,心率,体温和年龄;对于低炎症性败血症 (AUROC 0.84) 的表现更好.
结论:
- 对PCI/CCI的右ML模型显示了强大的内部败血症排除能力,但有限的跨人群通用性.
- 这些发现强调了对特定人口的预测模型的必要性.
- 在为PCI/CCI患者在临床实践中实施这些ML模型之前,前性验证至关重要.
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