Rank Nina, Pfahringer Boris, Kempfert Jörg, Stamm Christof, Kühne Titus, Schoenrath Felix, Falk Volkmar, Eickhoff Carsten, Meyer Alexander
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany.
NPJ Digit Med. 2020 Oct 26;3:139. doi: 10.1038/s41746-020-00346-8. eCollection 2020.
Acute kidney injury (AKI) is a major complication after cardiothoracic surgery. Early prediction of AKI could prompt preventive measures, but is challenging in the clinical routine. One important reason is that the amount of postoperative data is too massive and too high-dimensional to be effectively processed by the human operator. We therefore sought to develop a deep-learning-based algorithm that is able to predict postoperative AKI prior to the onset of symptoms and complications. Based on 96 routinely collected parameters we built a recurrent neural network (RNN) for real-time prediction of AKI after cardiothoracic surgery. From the data of 15,564 admissions we constructed a balanced training set (2224 admissions) for the development of the RNN. The model was then evaluated on an independent test set (350 admissions) and yielded an area under curve (AUC) (95% confidence interval) of 0.893 (0.862-0.924). We compared the performance of our model against that of experienced clinicians. The RNN significantly outperformed clinicians (AUC = 0.901 vs. 0.745, < 0.001) and was overall well calibrated. This was not the case for the physicians, who systematically underestimated the risk ( < 0.001). In conclusion, the RNN was superior to physicians in the prediction of AKI after cardiothoracic surgery. It could potentially be integrated into hospitals' electronic health records for real-time patient monitoring and may help to detect early AKI and hence modify the treatment in perioperative care.
急性肾损伤(AKI)是心胸外科手术后的主要并发症。对AKI进行早期预测可促使采取预防措施,但在临床实践中具有挑战性。一个重要原因是术后数据量巨大且维度过高,人工操作员难以有效处理。因此,我们试图开发一种基于深度学习的算法,能够在症状和并发症出现之前预测术后AKI。基于96个常规收集的参数,我们构建了一个循环神经网络(RNN),用于实时预测心胸外科手术后的AKI。从15564例入院患者的数据中,我们构建了一个平衡训练集(2224例入院患者)用于RNN的开发。然后在一个独立测试集(350例入院患者)上对该模型进行评估,其曲线下面积(AUC)(95%置信区间)为0.893(0.862 - 0.924)。我们将我们模型的性能与经验丰富的临床医生的性能进行了比较。RNN的表现显著优于临床医生(AUC = 0.901对0.745,< 0.001),并且总体校准良好。而医生并非如此,他们系统性地低估了风险(< 0.001)。总之,在预测心胸外科手术后的AKI方面,RNN优于医生。它有可能被整合到医院的电子健康记录中用于实时患者监测,并可能有助于早期发现AKI,从而在围手术期护理中调整治疗方案。
J Am Med Inform Assoc. 2022-12-13
Zhonghua Shao Shang Za Zhi. 2018-6-20
J Med Internet Res. 2025-3-18
BMC Med Inform Decis Mak. 2024-11-14
Lancet Respir Med. 2018-9-28
Can J Kidney Health Dis. 2018-6-8
AMIA Annu Symp Proc. 2018-4-16
Nat Rev Nephrol. 2017-9-4
Nephron. 2017