预测艾滋病毒感染者首次和多次抗逆转录病毒治疗中断:使用Cox和可解释的机器学习模型进行比较生存分析
Donald Salami1, Emily Koech2, Janet M Turan3
1Center for International Health, Education and Biosecurity, Institute of Human Virology, School of Medicine, University of Maryland, 725 W Lombard St, Baltimore, MD, 21201, United States, 1 410-706-8614.
机器学习模型在预测抗逆转录病毒疗法 (ART) 患者的治疗中断方面明显优于传统的考克斯比例危险模型. 这些先进的模型提供了个性化的洞察力,以改善患者在护理中的保留.
科学领域:
- 医疗信息学 医疗信息学
- 生物统计学 生物统计学
- 医疗保健中的机器学习
背景情况:
- 考克斯比例危险 (CPH) 模型是分析抗逆转录病毒疗法 (ART) 中治疗时间中断的标准.
- 机器学习 (ML) 模型在处理复杂,非线性关系和用于时间数据分析的大数据集方面具有优势.
研究的目的:
- 比较CPH和ML模型对ART治疗中断的预测性能.
- 为个性化干预提供全球和个人层面的解释,以改善治疗持续性.
主要方法:
- 利用了肯尼亚 (2017-2023) 启动ART的621,115名患者的数据.
- 将CPH与ML模型进行比较 (梯度提升,XGBoost,规范化的GLM,递归分区).
- 应用模型不可知解释性技术 (变量重要性,PDP,SHAP,LIME,等等) 进行解释.
主要成果:
- 递归分区实现了最高的预测性能 (一致性指数:0.81第一次,0.89多次中断).
- ML模型的表现优于CPH (CPH分数:0.78第一次,0.87多次中断).
- 可解释性方法提供了对变量重要性和个体患者风险因素的见解.
结论:
- ML模型表明ART治疗中断的优越预测能力.
- 来自ML模型的患者特异性风险预测可以指导针对性的干预措施.
- 提高ML模型的可解释性支持个性化护理策略,以改善治疗保留.
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