Optimal mean arterial pressure for favorable neurological outcomes in patients after cardiac arrest.

IF 4.7 2区 医学 Q1 CRITICAL CARE MEDICINE
Sijin Lee, Kwang-Sig Lee, Kap Su Han, Juhyun Song, Sung Woo Lee, Su Jin Kim
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引用次数: 0

Abstract

Background: Optimal mean arterial pressure (MAP) range after cardiac arrest remains uncertain. This study aimed to investigate the association between MAP and neurological outcomes during the early post-resuscitation period, with the goal of identifying optimal MAP range associated with favorable outcomes.

Methods: This retrospective observational study included 291 post-cardiac arrest patients treated at a tertiary care center. Five machine learning models to predict favorable neurological outcomes using hourly MAP measurements during the first 24 h after return of spontaneous circulation (ROSC) were compared and Random Forest model was selected due to its superior performance. Variable importance and Shapley Additive exPlanations (SHAP) were used to investigate the association between MAP and favorable neurological outcomes. SHAP dependence plots were used to identify optimal MAP ranges associated with favorable outcomes. In addition, individual-level predictions were interpreted using local interpretable model-agnostic explanations (LIME) and SHAP force plots.

Results: Machine learning analysis showed that MAP were associated with favorable neurological outcomes, with higher variable importance during the first 6 h after ROSC. SHAP analysis revealed an inverted U-shaped relationship between MAP and favorable neurological outcomes, with an optimal threshold of 79.56 mmHg (IQR: 73.70-82.54). This threshold remained consistent across both early (1-6 h: 79.26 mmHg) and later (7-24 h: 80.09 mmHg) hours. Individual-level explanations using SHAP and LIME highlighted that maintaining higher MAP during the early post-resuscitation period contributed positively to outcome predictions.

Conclusions: Machine learning analysis identified MAP as a major predictor of favorable neurological outcomes, with higher variable importance during the first 6 h after ROSC. MAP showed an inverted U-shaped relationship with favorable neurological outcomes, with an optimal threshold of approximately 80 mmHg.

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心脏骤停后患者有利神经预后的最佳平均动脉压。
背景:心脏骤停后的最佳平均动脉压(MAP)范围仍不确定。本研究旨在探讨复苏后早期MAP与神经预后之间的关系,目的是确定与有利预后相关的最佳MAP范围。方法:本回顾性观察研究纳入291例在三级保健中心接受治疗的心脏骤停后患者。我们比较了五种机器学习模型,通过自动循环(ROSC)恢复后的前24小时每小时MAP测量来预测有利的神经预后,并选择了随机森林模型,因为它的性能优越。采用可变重要性和Shapley加性解释(SHAP)来研究MAP与良好神经预后之间的关系。SHAP依赖图用于确定与有利结果相关的最佳MAP范围。此外,使用局部可解释模型不可知论解释(LIME)和SHAP力图来解释个人水平的预测。结果:机器学习分析显示,MAP与良好的神经预后相关,在ROSC后的前6小时具有较高的变量重要性。SHAP分析显示MAP与良好的神经预后呈倒u型关系,最佳阈值为79.56 mmHg (IQR: 73.70-82.54)。这一阈值在早期(1-6小时:79.26 mmHg)和后期(7-24小时:80.09 mmHg)保持一致。使用SHAP和LIME的个人水平解释强调,在复苏后早期维持较高的MAP有助于结果预测。结论:机器学习分析确定MAP是有利神经预后的主要预测因子,在ROSC后的前6小时具有较高的变量重要性。MAP与良好的神经预后呈倒u型关系,最佳阈值约为80 mmHg。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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