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.
Sci Rep. 2022 May 27;12(1):8956. doi: 10.1038/s41598-022-13152-x.
Acute kidney injury (AKI) is common among hospitalized children and is associated with a poor prognosis. The study sought to develop machine learning-based models for predicting adverse outcomes among hospitalized AKI children. We performed a retrospective study of hospitalized AKI patients aged 1 month to 18 years in the Second Xiangya Hospital of Central South University in China from 2015 to 2020. The primary outcomes included major adverse kidney events within 30 days (MAKE30) (death, new renal replacement therapy, and persistent renal dysfunction) and 90-day adverse outcomes (chronic dialysis and death). The state-of-the-art machine learning algorithm, eXtreme Gradient Boosting (XGBoost), and the traditional logistic regression were used to establish prediction models for MAKE30 and 90-day adverse outcomes. The models' performance was evaluated by split-set test. A total of 1394 pediatric AKI patients were included in the study. The incidence of MAKE30 and 90-day adverse outcomes was 24.1% and 8.1%, respectively. In the test set, the area under the receiver operating characteristic curve (AUC) of the XGBoost model was 0.810 (95% CI 0.763-0.857) for MAKE30 and 0.851 (95% CI 0.785-0.916) for 90-day adverse outcomes, The AUC of the logistic regression model was 0.786 (95% CI 0.731-0.841) for MAKE30 and 0.759 (95% CI 0.654-0.864) for 90-day adverse outcomes. A web-based risk calculator can facilitate the application of the XGBoost models in daily clinical practice. In conclusion, XGBoost showed good performance in predicting MAKE30 and 90-day adverse outcomes, which provided clinicians with useful tools for prognostic assessment in hospitalized AKI children.
急性肾损伤(AKI)在住院儿童中很常见,与预后不良有关。本研究旨在建立基于机器学习的模型,以预测住院 AKI 儿童的不良结局。我们对 2015 年至 2020 年期间在中国中南大学湘雅二医院住院的 1 个月至 18 岁 AKI 患儿进行了回顾性研究。主要结局包括 30 天内(MAKE30)的主要不良肾脏事件(死亡、新的肾脏替代治疗和持续的肾功能障碍)和 90 天不良结局(慢性透析和死亡)。使用最先进的机器学习算法,极端梯度提升(XGBoost)和传统的逻辑回归来建立 MAKE30 和 90 天不良结局的预测模型。通过分割测试评估模型的性能。共有 1394 例儿科 AKI 患者纳入研究。MAKE30 和 90 天不良结局的发生率分别为 24.1%和 8.1%。在测试集中,XGBoost 模型的接收器操作特征曲线(AUC)下面积为 0.810(95%置信区间 0.763-0.857),用于 MAKE30,0.851(95%置信区间 0.785-0.916)用于 90 天不良结局,逻辑回归模型的 AUC 为 0.786(95%置信区间 0.731-0.841),用于 MAKE30,0.759(95%置信区间 0.654-0.864)用于 90 天不良结局。一个基于网络的风险计算器可以方便 XGBoost 模型在日常临床实践中的应用。总之,XGBoost 在预测 MAKE30 和 90 天不良结局方面表现良好,为临床医生提供了评估住院 AKI 儿童预后的有用工具。
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