更新专有败血症预测模型的多中心前性验证
Andrew Wong1, Danielle Currey2,3, Megan Schwinne4
1University of Michigan Medical School, Ann Arbor.
JAMA network open
|February 27, 2026
概括
史诗性败血症模型v2显示,在4个卫生系统中改善了早期败血症预测. 然而,它具有很高的可变性,较低的积极预测值,以及高度的警报负担,影响临床采用.
科学领域:
- 临床信息学 临床信息学
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 史诗性败血症模型版本2 (ESM v2) 是一个广泛使用的败血症预测工具.
- 外部验证对于指导其在各种临床环境中的采用和使用至关重要.
研究的目的:
- 执行ESM v2.2.的多中心验证.
- 将ESM v2的表现与之前的ESM v1.1进行比较.
- 评估ESM v2性能相对于临床医生对败血症的识别.
主要方法:
- 一项涉及成年住院患者在4个大型美国卫生系统的预后研究.
- 在新模型实施后收集的数据,使用Sepsis-3标准进行分析.
- 通过AUROC评估的模型歧视;使用订单数据与临床医生的认可进行性能比较.
主要成果:
- 对于ESM v2的遭遇级AUROC在各个站点之间从0.82到0.92不等.
- 预测水平的AUROC (12小时视界) 范围在0.75到0.85.
- 与临床医生认可相比,ESM v2显示性能略有下降,具有较低的积极预测值 (0.13-0.26).
结论:
- 对ESM v2的多中心验证证明了早期败血症预测歧视的改善.
- 观察到显著的机构变化,低的积极预测值和高警报负担.
- 这些发现凸显了需要在临床实践中仔细考虑模型性能和警报管理的必要性.
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