Desarrollo de una escala predictiva en pacientes con shock séptico refractario mediante un modelo híbrido de aprendizaje automático y regresión.
Objective. To develop a scale to predict refractory septic shock (SS) based on clinical variables recorded during initial evaluations of patients. Methods. Multicenter retrospective study of data for patients with suspected infection registered in the Marketplace for Medical Information in Intensive...
| Published in: | Emergencias Vol. 37; no. 1; pp. 15 - 23 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Revista Emergencias
Feb2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=182636529&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 182636529 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 11376821 ESKG jtl: Emergencias issn: 11376821 maglogo: N pubinfo: dt: Feb2025 vid: 37 iid: 1 pid: 95363 pub: Revista Emergencias artinfo: ui: 182636529 182636529 182636529 10.55633/s3me/108.2024 182636529 ppf: 15 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Desarrollo de una escala predictiva en pacientes con shock séptico refractario mediante un modelo híbrido de aprendizaje automático y regresión. aug: au: Sejin Heo Daun Jeong Minyoung Choi Inkyu Kim Minha Kim Ye Rim Lee Byuk Sung Ko Seung Mok Ryoo Eunah Han Hyunglan Chang Chang June Yune Hui Jai Lee Gil Joon Suh Sung-Hyuk Choi Sung Phil Chung Tae Ho Lim Won Young Kim Kyuseok Kim Sung Yeon Hwang Jong Eun Park affil: Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea sug: subj: Instrument Construction Instrument Validation Shock, Septic Risk Factors Risk Assessment Machine Learning Scales Evaluation Psychometrics Evaluation Human Multicenter Studies Retrospective Design Record Review Prospective Studies Validation Studies Descriptive Statistics Confidence Intervals Lactates Blood Systolic Pressure Heart Rate Body Temperature Leukocyte Count ab: Objective. To develop a scale to predict refractory septic shock (SS) based on clinical variables recorded during initial evaluations of patients. Methods. Multicenter retrospective study of data for patients with suspected infection registered in the Marketplace for Medical Information in Intensive Care (MIMIC-IV). These data were used for the development and internal validation of the refractory SS scale (RSSS). For external validation, we used retrospective data for 2 cohorts: 1) patients diagnosed with SS in an emergency department (ED cohort) whose data were registered in a Korean SS registry, and 2) patients diagnosed with SS in 6 hospital intensive care units (ICU cohort). A machine-learning automatic clinical scoring system (AutoScore) was used in the development phase. The performance of the RSSS in the validation cohorts was assessed with the area under the receiver operating characteristic curve (AUROC) for each. The primary outcome was the development of refractory SS within 24 hours of ICU admission. Refractory SS was defined by the need for a norepinephrine-equivalent dose greater than 0.5 µg/kg/min. Results. We collected data for 29 618 patients from the MIMIC-IV registry, 3113 patients for the ED cohort, and 1015 for the ICU cohort. The RSSS had 6 predictors: serum lactate level, systolic blood pressure, heart rate, temperature, arterial pH, and leukocyte count. The scale's AUROCs were as follows: 0.873 (95% CI, 0.846-0.900) in the internal validation, 0.705 (95% CI, 0.678-0.733) in the ED cohort on arrival, 0.781 (95% CI, 0.757-0.805) in the ED cohort at the moment of diagnosing hypoperfusion or hypotension, and 0.822 (95% CI, 0.787-0.857) in the ICU cohort. Calibration was acceptable in all the cohorts. Conclusion. The RSSS had adequate diagnostic accuracy in multiple cohorts of patients diagnosed in the ED and ICU. Objetivos. Desarrollar una escala predictiva en pacientes con shock séptico (SS) refractario basada en parámetros clínicos disponibles en la valoración inicial. Métodos. Estudio multicéntrico y retrospectivo que analizó pacientes de la base MIMIC-IV (Marketplace for Medical Information in Intensive Care) para la derivación y validación interna de la escala. Se realizó una validación externa con pacientes con SS diagnosticados en el servicio de urgencias (cohorte SU) y con pacientes diagnosticados en la unidad de cuidados intensivos (cohorte UCI). La escala de SS refractario (ESSR) se desarrolló con AutoScore. El rendimiento se analizó mediante el área bajo la curva (ABC) de la curva operativa del receptor (ROC). El resultado primario fue el desarrollo de SS refractario en las 24 horas siguientes al ingreso en la UCI o de la llegada al SU, definido como la necesidad de una dosis equivalente de noradrenalina superior a 0,5 µg/kg/min. Resultados. Se analizaron 29.618 pacientes de la base MIMIC-IV, 3.113 de la cohorte SU y 1.015 de la cohorte UCI. La ESSR incluyó seis variables: lactato, presión arterial sistólica, frecuencia cardiaca, temperatura, pH arterial y cifra de leucocitos. El ABC ROC fue de 0,873 (IC 95%: 0,846-0,900) en la validación interna; 0,705 (IC 95% 0,678-0,733) en la cohorte SU a su llegada y 0,781 (IC 95%: 0,757-0,805) en el momento de la hipoperfusión o hipotensión; y 0,822 (IC 95%: 0,787-0,857) en la cohorte UCI. La calibración fue aceptable en todas las cohortes. Conclusiones. La ESSR tuvo una precisión diagnóstica adecuada en múltiples cohortes de validación de pacientes incluidos en el SU y en la UCI. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: Spanish refInfo: holdings: @attributes: islocal: N |
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