缺血性脑卒中危重患者脉搏波速度估算与全因死亡率的关系:回顾性队列研究及基于机器学习的预测模型建立

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Shuangmei Zhao, Chang Zhu, Yu Guo, Shiyin Ma, Chucheng Jiao, Liutao Sui, Rongyao Hou, Xiaoyan Zhu
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引用次数: 0

摘要

背景:估计脉搏波速度(ePWV)已被确立为一种简单而有效的评估动脉僵硬度和预测长期心脑血管死亡率的工具。然而,ePWV与危重患者缺血性卒中(IS)预后不良之间的关系仍未得到充分研究。本研究旨在探讨重症IS患者ePWV与不良结局的关系。方法:我们采用重症监护医疗信息市场IV (MIMIC-IV, 3.0版)的数据进行回顾性队列研究,按ePWV四分位数分层。我们的主要目的是检查关键时间段的死亡率:观察后30天、90天和1年。Kaplan-Meier (KM)曲线、Cox比例风险模型、限制性三次样条曲线(RCS)和亚组分析对这些分析进行了补充,以全面评估ePWV与全因死亡率之间的关系。为了对死亡风险进行建模,采用了四种机器学习算法,即Logistic回归(LR)、随机森林(RF)、XGBoost和朴素贝叶斯(NB)。使用Shapley加性解释(SHAP)分析提高了模型的可解释性,并通过校准验证了预测的准确性。我们将四种机器学习算法(LR、RF、XGBoost、NB)与五种临床风险评分进行了全面比较。结果:我们的分析包括1337例患者,男性优势为51.6%。30天、90天和1年死亡率分别为14.1%、17.9%和23.4%。RCS分析显示ePWV水平越高,全因死亡风险呈剂量依赖性增加。ePWV最高四分位数的危重IS患者在所有时间点的死亡率均显著高于较低四分位数。Boruta特征选择将ePWV确定为关键预测因子。LR模型在预测30天死亡率方面表现出更高的准确性,而XGBoost在预测90天和1年死亡率方面优于其他模型。结论:ePWV水平升高对危重IS患者的短期和长期死亡率具有很强的预后价值。纳入ePWV的机器学习模型优于传统的临床评分,表明急性卒中管理风险分层的潜在效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association between estimation of pulse wave velocity and all-cause mortality in critically ill patients with ischemic stroke: a retrospective cohort study and predictive model establishment based on machine learning.

Background: Estimated pulse wave velocity (ePWV) has been established as a simple yet effective tool for assessing arterial stiffness and predicting long-term cardiovascular and cerebrovascular mortality. However, the association between ePWV and poor prognosis in critically ill patients with ischemic stroke (IS) remains understudied. This study aimed to investigate the relationship between ePWV and adverse outcomes in critically ill IS patients.

Methods: We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.0), stratified by ePWV quartiles. Our primary objective was to examine mortality rates at pivotal timeframes: 30 days, 90 days, and 1-year post-observation. Kaplan-Meier (KM) curves complemented these analyses, along with a Cox proportional hazards model, restricted cubic spline curves (RCS), and subgroup analysis, to comprehensively evaluate the association between ePWV and all-cause mortality. To model the mortality risk, four machine learning algorithms were employed, namely Logistic Regression (LR), Random Forest (RF), XGBoost, and Naive Bayes (NB). Model interpretability was improved using Shapley Additive Interpretation (SHAP) analysis, with calibration validating predictive accuracy. We comprehensively compared four machine learning algorithms (LR, RF, XGBoost, NB) against five clinical risk scores.

Results: Our analysis encompassed a cohort of 1,337 patients, with a male preponderance of 51.6%. The 30-day, 90-day, and 1-year mortality rates were 14.1%, 17.9%, and 23.4%, respectively. The RCS analysis revealed a dose-dependent increase in all-cause mortality risk with higher ePWV levels. Critically ill IS patients in the highest ePWV quartile had significantly higher mortality at all time points compared to lower quartiles. Boruta feature selection identified ePWV as a key predictor. The LR model demonstrated superior accuracy in predicting 30-day mortality, while XGBoost outperformed others for 90-day and 1-year mortality predictions.

Conclusion: Elevated levels of the ePWV demonstrate strong prognostic value for both short- and long-term mortality in critically ill IS patients. Machine learning models incorporating ePWV outperformed traditional clinical scores, suggesting potential utility for risk stratification in acute stroke management.

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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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