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中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 428 -433. doi: 10.3877/cma.j.issn.1674-6880.2023.05.014

综述

基于机器学习的脓毒症早期预测研究进展
唐明坤, 孙海霞, 吴思竹, 钱庆()   
  1. 100020 北京,北京协和医学院/中国医学科学院医学信息研究所医学数据共享研究室
  • 收稿日期:2022-12-16 出版日期:2023-10-31
  • 通信作者: 钱庆
  • 基金资助:
    中国医学科学院项目"医学与健康科技创新工程"(2021-I2M-1-057)
  • Received:2022-12-16 Published:2023-10-31
引用本文:

唐明坤, 孙海霞, 吴思竹, 钱庆. 基于机器学习的脓毒症早期预测研究进展[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 428-433.

脓毒症是危重症医学面临的一个重要临床问题。在世界范围内,每年有超过1 900万人患有脓毒症,其中死亡人数达到600万,病死率超过1/4,存活的患者中也有近300万人存在认知功能障碍[1]。脓毒症是ICU患者的主要死亡原因之一,而早期诊断能够明显降低脓毒症的发病率和病死率,并有效提高治愈率[2]。传统的脓毒症诊断金标准血培养方法存在耗时长、阳性率低的问题。随着脓毒症诊疗指南的更新,多个用于早期诊断脓毒症的评分系统如快速序贯器官衰竭评估(quick sequential organ failure assessment,qSOFA)[3]、英国国家早期预警评分系统(national early warning score,NEWS)[4]等被相继提出。这些评分系统虽然具备快速评价和风险分层的功能,但仍存在诊断时效性较差和准确性不足的问题。

表1 构建脓毒症预测模型的主要数据库
数据库 简介 数据规模 变量类型及数量 部分代表性文献
PhysioNet/CinC Challenge data 第20届全球生理测量挑战赛使用的公开数据库,包含美国3个不同医院的电子病历数据,分别是贝斯以色列女执事医疗中心(系统A)、埃默里大学医院(系统B)以及第3个不明医院(系统C)的系统。每个患者在ICU期间每小时记录一次数据,按Sepsis-3临床标准进行标记,共收集了1 407 716 h的数据并进行标记 包含40 336例ICU患者的公开记录标签,其中脓毒症阳性标记的有2 932条,24 819例患者的记录作为隐藏测试集 数据包含40个临床变量(8个生命体征变量,26个实验室变量,6个人口统计学变量) [11]、[12]、[15]、[16]、[17]
MIMIC-Ⅲ MIMIC-Ⅲ是一个免费的大型数据库,包含2001年至2012年期间在贝斯以色列女执事医疗中心ICU住院的去标志化数据。MIMIC数据集有多个版本,目前最新的版本是2016年9月发布的MIMIC-Ⅲ v1.4 包含4万多例患者的临床记录,其中脓毒症患病率约7% 该数据库由26个子表构成,包括人口统计、生命体征、实验室检查、药物、文本记录等变量 [18]、[19]、[20]、[21]、[22]
UCSF UCSF的数据来自加州大学旧金山分校医学中心,包含2011年6月至2016年3月3个分校区的17 467 987次住院和门诊就诊数据 包含ICU、急诊科和楼层单元共96 646例18岁以上的住院患者数据,其中脓毒症患病率约2% 生命体征等变量 [6]、[23]
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