预测危重患者血乳酸值的回顾性多中心队列研究
Prediction of Blood Lactate Values in Critically Ill Patients: A Retrospective Multi-center Cohort Study
摘要：
目的.最初获得的血清乳酸水平升高是危重患者死亡率的强预测因子。识别血清乳酸水平更有可能增加的患者可以提醒医生加强护理，并指导他们进行血液检查的频率。我们研究机器学习模型是否可以预测随后的血清乳酸变化。方法.我们使用MIMIC-III和eICU-CRD数据集在MIMIC-III队列的eICU队列的内部和外部验证中研究了血清乳酸变化预测。根据初始乳酸水平定义三个亚组：i）正常组（<2 mmol/L），ii）轻度组（2-4 mmol/L），和iii）重度组（>4 mmol/L）。根据组间血清乳酸水平的升高或降低来定义结局。我们还进行了敏感性分析，将结果定义为乳酸变化>10%，并进一步研究了后续乳酸测量之间的时间间隔对预测性能的影响。结果LSTM模型能够预测MIMIC-III患者血清乳酸值的恶化，AUC为0.77（95% CI 0.762-0.771）正常组，0.77（95% CI 0.768-0.772），重度组为0.85（95% CI 0.840-0.851），在外部验证中表现略低。结论LSTM证明了对血清乳酸水平恶化的患者的良好区分。需要临床研究来评估基于这些结果的临床决策支持工具的利用是否会对决策和患者结局产生积极影响。
英文摘要：
Purpose. Elevations in initially obtained serum lactate levels are strong predictors of mortality in critically ill patients. Identifying patients whose serum lactate levels are more likely to increase can alert physicians to intensify care and guide them in the frequency of tending the blood test. We investigate whether machine learning models can predict subsequent serum lactate changes. Methods. We investigated serum lactate change prediction using the MIMIC-III and eICU-CRD datasets in internal as well as external validation of the eICU cohort on the MIMIC-III cohort. Three subgroups were defined based on the initial lactate levels: i) normal group (<2 mmol/L), ii) mild group (2-4 mmol/L), and iii) severe group (>4 mmol/L). Outcomes were defined based on increase or decrease of serum lactate levels between the groups. We also performed sensitivity analysis by defining the outcome as lactate change of >10% and furthermore investigated the influence of the time interval between subsequent lactate measurements on predictive performance. Results. The LSTM models were able to predict deterioration of serum lactate values of MIMIC-III patients with an AUC of 0.77 (95% CI 0.762-0.771) for the normal group, 0.77 (95% CI 0.768-0.772) for the mild group, and 0.85 (95% CI 0.840-0.851) for the severe group, with a slightly lower performance in the external validation. Conclusion. The LSTM demonstrated good discrimination of patients who had deterioration in serum lactate levels. Clinical studies are needed to evaluate whether utilization of a clinical decision support tool based on these results could positively impact decision-making and patient outcomes.
机构、总结、中文摘要均由AI分析而来，可能存在错误，请以论文正文为准。
