Machine Learning to Predict Individualized Treatment Effects of Sodium Bicarbonate for Patients With Out-of-Hospital Cardiac Arrest.

IF 6 1区 医学 Q1 CRITICAL CARE MEDICINE
Chi-Hsin Chen, Cheng-Yi Fan, Yi-Chien Kuo, Chih-Hung Wang, Hung-Wen Chiu, Edward Pei-Chuan Huang
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引用次数: 0

Abstract

Objectives: Current evidence regarding the effect of sodium bicarbonate (SB) on patients with out-of-hospital cardiac arrest (OHCA) remains unclear. This study aimed to develop a machine-learning model to predict the individualized treatment effect (ITE) of SB use in OHCA patients.

Design: An eXtreme Gradient Boosting-based causal forest model was developed using an 8-year retrospective OHCA database after propensity score matching (PSM) for age, serum potassium, pH, bicarbonate, and Pco2 level.

Setting: Multicenter study across three hospitals affiliated with the National Taiwan University Hospital system.

Patients: Adult patients with nontraumatic OHCA.

Interventions: None.

Measurements and main results: The main outcome was any return of spontaneous circulation (ROSC) following resuscitation in the emergency department. Covariates included age, sex, witness status, bystander cardiopulmonary resuscitation, arrest location, response time, scene-to-hospital time, defibrillation using automatic external defibrillators, prehospital advanced airway type and epinephrine administration, initial cardiac rhythm, and laboratory data. The PSM cohort included 2368 patients. The ROSC rate was not different between the SB-treated and untreated groups. The predicted ITE ranged from a 24.7% absolute increase to a 28.3% absolute reduction in ROSC when SB was administered. The tertile of the predicted ITE significantly modified the effect of the original clinician treatment assignment on outcome (p < 0.001), and it can discriminate patients who benefit from SB better than random allocation when assessed by the Qini curve and C-for-benefit (0.61). Factors associated with higher predicted benefit from SB administration included older age, poorer renal function, longer scene-to-hospital time, metabolic acidosis, and hyperkalemia.

Conclusions: This study suggests the heterogeneous effects of SB on ROSC rates in patients with OHCA. The developed model may help identify specific subgroups more likely to benefit or be harmed by treatment. Further external validations and clinical trials are still needed to evaluate the model.

机器学习预测碳酸氢钠对院外心脏骤停患者的个体化治疗效果。
目的:目前关于碳酸氢钠(SB)对院外心脏骤停(OHCA)患者影响的证据尚不清楚。本研究旨在建立一种机器学习模型来预测OHCA患者使用SB的个体化治疗效果(ITE)。设计:利用年龄、血清钾、pH、碳酸氢盐和二氧化碳浓度的倾向评分匹配(PSM)后的8年回顾性OHCA数据库,建立了基于极端梯度增强的因果森林模型。背景:台大附属三家医院的多中心研究。患者:非创伤性OHCA的成年患者。干预措施:没有。测量方法和主要结果:主要结果是急诊复苏后自发性循环(ROSC)的恢复。协变量包括年龄、性别、证人状态、旁观者心肺复苏、骤停位置、反应时间、从现场到医院的时间、使用自动体外除颤器除颤、院前先进气道类型和肾上腺素管理、初始心律和实验室数据。PSM队列包括2368例患者。sb治疗组和未治疗组的ROSC率无显著差异。当给予SB时,预测的ITE范围从ROSC的24.7%绝对增加到28.3%绝对减少。预测ITE的五位数显著改善了原始临床医生治疗分配对结果的影响(p < 0.001),并且在使用Qini曲线和C-for-benefit(0.61)评估时,它可以比随机分配更好地区分从SB获益的患者。与SB给药较高预期获益相关的因素包括年龄较大、肾功能较差、从现场到医院的时间较长、代谢性酸中毒和高钾血症。结论:本研究提示SB对OHCA患者ROSC率的异质性影响。开发的模型可能有助于确定更有可能受益或受到治疗伤害的特定亚群。还需要进一步的外部验证和临床试验来评估该模型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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