Department of Intensive Care Medicine, Department of Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China.
Luzhou Key Laboratory of Human Microecology and Precision Diagnosis and Treatment, Luzhou, China.
PLoS One. 2024 May 20;19(5):e0303469. doi: 10.1371/journal.pone.0303469. eCollection 2024.
Sepsis-Associated Liver Injury (SALI) is an independent risk factor for death from sepsis. The aim of this study was to develop an interpretable machine learning model for early prediction of 28-day mortality in patients with SALI. Data from the Medical Information Mart for Intensive Care (MIMIC-IV, v2.2, MIMIC-III, v1.4) were used in this study. The study cohort from MIMIC-IV was randomized to the training set (0.7) and the internal validation set (0.3), with MIMIC-III (2001 to 2008) as external validation. The features with more than 20% missing values were deleted and the remaining features were multiple interpolated. Lasso-CV that lasso linear model with iterative fitting along a regularization path in which the best model is selected by cross-validation was used to select important features for model development. Eight machine learning models including Random Forest (RF), Logistic Regression, Decision Tree, Extreme Gradient Boost (XGBoost), K Nearest Neighbor, Support Vector Machine, Generalized Linear Models in which the best model is selected by cross-validation (CV_glmnet), and Linear Discriminant Analysis (LDA) were developed. Shapley additive interpretation (SHAP) was used to improve the interpretability of the optimal model. At last, a total of 1043 patients were included, of whom 710 were from MIMIC-IV and 333 from MIMIC-III. Twenty-four clinically relevant parameters were selected for model construction. For the prediction of 28-day mortality of SALI in the internal validation set, the area under the curve (AUC (95% CI)) of RF was 0.79 (95% CI: 0.73-0.86), and which performed the best. Compared with the traditional disease severity scores including Oxford Acute Severity of Illness Score (OASIS), Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score II (SAPS II), Logistic Organ Dysfunction Score (LODS), Systemic Inflammatory Response Syndrome (SIRS), and Acute Physiology Score III (APS III), RF also had the best performance. SHAP analysis found that Urine output, Charlson Comorbidity Index (CCI), minimal Glasgow Coma Scale (GCS_min), blood urea nitrogen (BUN) and admission_age were the five most important features affecting RF model. Therefore, RF has good predictive ability for 28-day mortality prediction in SALI. Urine output, CCI, GCS_min, BUN and age at admission(admission_age) within 24 h after intensive care unit(ICU) admission contribute significantly to model prediction.
脓毒症相关性肝损伤 (SALI) 是脓毒症死亡的独立危险因素。本研究旨在开发一种可解释的机器学习模型,用于早期预测 SALI 患者 28 天死亡率。本研究使用了来自医疗信息集市重症监护 (MIMIC-IV,v2.2,MIMIC-III,v1.4) 的数据。MIMIC-IV 中的研究队列被随机分配到训练集 (0.7) 和内部验证集 (0.3),MIMIC-III (2001 年至 2008 年) 作为外部验证。删除缺失值超过 20%的特征,并对剩余特征进行多次内插。使用 Lasso-CV 选择重要特征进行模型开发,Lasso-CV 是一种通过沿着正则化路径进行迭代拟合的lasso 线性模型,通过交叉验证选择最佳模型。共开发了 8 种机器学习模型,包括随机森林 (RF)、逻辑回归、决策树、极端梯度提升 (XGBoost)、K 最近邻、支持向量机、广义线性模型,其中最佳模型通过交叉验证 (CV_glmnet) 选择,以及线性判别分析 (LDA)。Shapley 加法解释 (SHAP) 用于提高最优模型的可解释性。最后,共纳入 1043 例患者,其中 710 例来自 MIMIC-IV,333 例来自 MIMIC-III。选择了 24 个临床相关参数进行模型构建。在内部验证集中,RF 的曲线下面积 (AUC(95%CI)) 为 0.79(95%CI:0.73-0.86),表现最佳。与传统的疾病严重程度评分包括牛津急性疾病严重程度评分 (OASIS)、序贯器官衰竭评估 (SOFA)、简化急性生理学评分 II (SAPS II)、逻辑器官功能障碍评分 (LODS)、全身炎症反应综合征 (SIRS) 和急性生理学评分 III (APS III) 相比,RF 也具有最佳性能。SHAP 分析发现,尿量、Charlson 合并症指数 (CCI)、最小格拉斯哥昏迷量表 (GCS_min)、血尿素氮 (BUN) 和入院年龄是影响 RF 模型的五个最重要的特征。因此,RF 对 SALI 患者 28 天死亡率预测具有良好的预测能力。重症监护病房 (ICU) 入院后 24 小时内的尿量、CCI、GCS_min、BUN 和入院年龄(入院年龄)对模型预测有显著贡献。
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