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用于改善非重症监护病房住院患者脓毒症诊断的时间序列深度学习与共形预测

Time-Series Deep Learning and Conformal Prediction for Improved Sepsis Diagnosis in Non-ICU Hospitalized Patients.

作者信息

Dalal Shaunak, Ardabili Ahad Khaleghi, Bonavia Anthony S

机构信息

Department of Anesthesiology and Perioperative Medicine, 500 University Dr, Hershey, 17033, PA, USA.

Critical Illness and Sepsis Research Center, 700 HMC Cres Rd, Hershey, 17033, PA, USA.

出版信息

medRxiv. 2024 Nov 22:2024.11.21.24317716. doi: 10.1101/2024.11.21.24317716.

Abstract

PURPOSE

Sepsis, a life-threatening condition from an uncontrolled immune response to infection, is a leading cause of in-hospital mortality. Early detection is crucial, yet traditional diagnostic methods, like SIRS and SOFA, often fail to identify sepsis in non-ICU settings where monitoring is less frequent. Recent machine learning (ML) models offer new possibilities but lack generalizability and suffer from high false alarm rates.

METHODS

We developed a deep learning (DL) model tailored for non-ICU environments, using MIMIC-IV data with a conformal prediction framework to handle uncertainty. The model was trained on 83,813 patients and validated with the eICU-CRD dataset to test performance across hospital settings.

RESULTS

Our model predicted sepsis at 24, 12, and 6 h before onset, achieving AUROCs of 0.96, 0.98, and 0.99, respectively. The conformal approach reduced false positives and improved specificity. External validation confirmed similar performance, with a 57% reduction in false alarms at the 6 h window, supporting practical use in low-monitoring environments.

CONCLUSIONS

This DL-based model enables accurate, early sepsis prediction with minimal data, addressing key clinical challenges and potentially improving resource allocation in hospital settings by reducing unnecessary ICU admissions and enhancing timely interventions.

摘要

目的

脓毒症是一种因对感染的免疫反应失控而危及生命的病症,是院内死亡的主要原因。早期检测至关重要,但传统的诊断方法,如全身炎症反应综合征(SIRS)和序贯器官衰竭评估(SOFA),在监测频率较低的非重症监护病房(ICU)环境中往往无法识别脓毒症。最近的机器学习(ML)模型提供了新的可能性,但缺乏通用性且误报率高。

方法

我们使用具有共形预测框架的多参数智能监测数据库(MIMIC-IV)数据开发了一种针对非ICU环境量身定制的深度学习(DL)模型,以处理不确定性。该模型在83813名患者身上进行了训练,并用电子ICU临床研究数据库(eICU-CRD)数据集进行了验证,以测试不同医院环境下的性能。

结果

我们的模型在脓毒症发作前24小时、12小时和6小时预测了脓毒症,受试者工作特征曲线下面积(AUROC)分别达到0.96、0.98和0.99。共形方法减少了误报并提高了特异性。外部验证证实了类似的性能,在6小时窗口内误报减少了57%,支持在低监测环境中的实际应用。

结论

这种基于深度学习的模型能够以最少的数据进行准确的早期脓毒症预测,解决了关键的临床挑战,并有可能通过减少不必要的ICU入院和加强及时干预来改善医院环境中的资源分配。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a58/11601686/75bc42ba58b1/nihpp-2024.11.21.24317716v1-f0001.jpg

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