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机器学习在鉴别脓毒症危重症患者急性肾损伤的一过性与持续性中的作用。

Machine learning for early discrimination between transient and persistent acute kidney injury in critically ill patients with sepsis.

机构信息

Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.

Information Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.

出版信息

Sci Rep. 2021 Oct 12;11(1):20269. doi: 10.1038/s41598-021-99840-6.


DOI:10.1038/s41598-021-99840-6
PMID:34642418
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8511088/
Abstract

Acute kidney injury (AKI) is commonly present in critically ill patients with sepsis. Early prediction of short-term reversibility of AKI is beneficial to risk stratification and clinical treatment decision. The study sought to use machine learning methods to discriminate between transient and persistent sepsis-associated AKI. Septic patients who developed AKI within the first 48 h after ICU admission were identified from the Medical Information Mart for Intensive Care III database. AKI was classified as transient or persistent according to the Acute Disease Quality Initiative workgroup consensus. Five prediction models using logistic regression, random forest, support vector machine, artificial neural network and extreme gradient boosting were constructed, and their performance was evaluated by out-of-sample testing. A simplified risk prediction model was also derived based on logistic regression and features selected by machine learning algorithms. A total of 5984 septic patients with AKI were included, 3805 (63.6%) of whom developed persistent AKI. The artificial neural network and logistic regression models achieved the highest area under the receiver operating characteristic curve (AUC) among the five machine learning models (0.76, 95% confidence interval [CI] 0.74-0.78). The simplified 14-variable model showed adequate discrimination, with the AUC being 0.76 (95% CI 0.73-0.78). At the optimal cutoff of 0.63, the sensitivity and specificity of the simplified model were 63% and 76% respectively. In conclusion, a machine learning-based simplified prediction model including routine clinical variables could be used to differentiate between transient and persistent AKI in critically ill septic patients. An easy-to-use risk calculator can promote its widespread application in daily clinical practice.

摘要

急性肾损伤(AKI)在脓毒症危重症患者中较为常见。早期预测 AKI 的短期可逆性有利于风险分层和临床治疗决策。本研究旨在使用机器学习方法区分短暂性和持续性脓毒症相关 AKI。从 Medical Information Mart for Intensive Care III 数据库中确定了 ICU 入院后 48 小时内发生 AKI 的脓毒症患者。根据急性疾病质量倡议工作组共识,将 AKI 分为短暂性或持续性。使用逻辑回归、随机森林、支持向量机、人工神经网络和极端梯度提升构建了五个预测模型,并通过样本外测试评估了它们的性能。还基于逻辑回归和机器学习算法选择的特征构建了简化风险预测模型。共纳入 5984 例 AKI 脓毒症患者,其中 3805 例(63.6%)患者发生持续性 AKI。在五个机器学习模型中,人工神经网络和逻辑回归模型的受试者工作特征曲线下面积(AUC)最高(0.76,95%置信区间[CI]0.74-0.78)。简化的 14 变量模型具有良好的判别能力,AUC 为 0.76(95%CI 0.73-0.78)。在最佳截断值 0.63 时,简化模型的敏感性和特异性分别为 63%和 76%。总之,基于机器学习的简化预测模型包括常规临床变量,可用于区分危重症脓毒症患者的短暂性和持续性 AKI。易于使用的风险计算器可以促进其在日常临床实践中的广泛应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/a1b313ccef2e/41598_2021_99840_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/c0a6da6bd269/41598_2021_99840_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/0762f5fc8437/41598_2021_99840_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/31baf12c7ab0/41598_2021_99840_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/6d2357621002/41598_2021_99840_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/a1b313ccef2e/41598_2021_99840_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/c0a6da6bd269/41598_2021_99840_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/0762f5fc8437/41598_2021_99840_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/31baf12c7ab0/41598_2021_99840_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/6d2357621002/41598_2021_99840_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c1c/8511088/a1b313ccef2e/41598_2021_99840_Fig5_HTML.jpg

相似文献

[1]
Machine learning for early discrimination between transient and persistent acute kidney injury in critically ill patients with sepsis.

Sci Rep. 2021-10-12

[2]
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J Transl Med. 2022-5-13

[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Review of research progress in sepsis-associated acute kidney injury.

Front Mol Biosci. 2025-7-11

[2]
Artificial Intelligence Models in Diagnosis and Treatment of Kidney Diseases: Current Status and Prospects.

Kidney Dis (Basel). 2025-6-12

[3]
Artificial intelligence models for predicting acute kidney injury in the intensive care unit: a systematic review of modeling methods, data utilization, and clinical applicability.

JAMIA Open. 2025-7-3

[4]
External Validation of Persistent Severe Acute Kidney Injury Prediction With Machine Learning Model.

Mayo Clin Proc Digit Health. 2025-2-24

[5]
Machine Learning to Assist in Managing Acute Kidney Injury in General Wards: Multicenter Retrospective Study.

J Med Internet Res. 2025-3-18

[6]
Construction and verification of a nomogram model for the risk of death in sepsis patients.

Sci Rep. 2025-2-11

[7]
Machine learning approaches toward an understanding of acute kidney injury: current trends and future directions.

Korean J Intern Med. 2024-11

[8]
Contrast-enhanced CT radiomics combined with multiple machine learning algorithms for preoperative identification of lymph node metastasis in pancreatic ductal adenocarcinoma.

Front Oncol. 2024-9-13

[9]
Effectiveness of Artificial Intelligence (AI) in Clinical Decision Support Systems and Care Delivery.

J Med Syst. 2024-8-12

[10]
Predictive models of sepsis-associated acute kidney injury based on machine learning: a scoping review.

Ren Fail. 2024-12

本文引用的文献

[1]
An Effective Machine Learning Approach for Identifying Non-Severe and Severe Coronavirus Disease 2019 Patients in a Rural Chinese Population: The Wenzhou Retrospective Study.

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