基于长短期记忆网络和Logistic回归的重症监护病房脑卒中患者院内死亡风险预测

doi:10.19723/j.issn.1671-167X.2022.03.010

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (3): 458-467. doi: 10.19723/j.issn.1671-167X.2022.03.010

基于长短期记忆网络和Logistic回归的重症监护病房脑卒中患者院内死亡风险预测

邓宇含¹,姜勇^2,³,王子尧¹,刘爽¹,汪雨欣¹,刘宝花^1,*()

1. 北京大学公共卫生学院社会医学与健康教育学系，北京 100191
2. 国家神经系统疾病临床医学研究中心，首都医科大学附属北京天坛医院神经病学中心，北京 100050
3. 北京大数据精准医疗高精尖创新中心(北京航空航天大学&首都医科大学)，北京 100070

收稿日期:2022-01-13 出版日期:2022-06-18 发布日期:2022-06-14
通讯作者: 刘宝花 E-mail:baohualiu@bjmu.edu.cn
基金资助:
国家重点研发计划(2018YFC1311700);国家重点研发计划(2018YFC1311703)

Long short-term memory and Logistic regression for mortality risk prediction of intensive care unit patients with stroke

Yu-han DENG¹,Yong JIANG^2,³,Zi-yao WANG¹,Shuang LIU¹,Yu-xin WANG¹,Bao-hua LIU^1,*()

1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
2. China National Clinical Research Center for Neurological Diseases, Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
3. Beijing Advanced Innovation Center for Big Data-Based Precision Medicine (Beihang University & Capital Medical University), Beijing 100070, China

Received:2022-01-13 Online:2022-06-18 Published:2022-06-14
Contact: Bao-hua LIU E-mail:baohualiu@bjmu.edu.cn
Supported by:
National Key R & D Program of China(2018YFC1311700);National Key R & D Program of China(2018YFC1311703)

摘要/Abstract

摘要：

目的: 基于引入注意力机制的长短期记忆网络(long short-term memory，LSTM)和L1正则化的Logistic回归筛选变量，再通过传统的Logistic回归建立重症监护病房(intensive care unit，ICU)脑卒中患者院内死亡风险预测模型并评价模型效果。方法: 选取重症医学信息数据库(Medical Information Mart for Intensive Care-Ⅳ，MIMIC-Ⅳ)中的脑卒中患者作为研究对象，以是否发生院内死亡作为结局变量，备选预测因子包括人口学特征、合并症、入院48 h内实验室检查和生命体征检查等。将数据根据结局指标以8 ∶2的比例随机进行10次训练集和测试集的划分，在训练集上构建LSTM和L1正则化的Logistic回归模型，在测试集上选取重要程度排名前10的变量的并集纳入Logistic回归建立预测模型，以受试者工作特征曲线下面积(area under curve, AUC)、灵敏度、特异度、预测准确度为指标对模型进行评价，并与未预先进行变量筛选的前进法Logistic回归模型的预测效果进行比较。结果: 共纳入2 755例脑卒中患者的2 979条ICU入院记录，其中院内死亡记录占17.66%。两个变量筛选模型中，L1正则化的Logistic回归模型的AUC显著优于LSTM模型(0.819±0.031 vs. 0.760±0.018, P < 0.001)，两个模型中重要程度均位于前10的变量包括年龄、血糖和尿素氮。最终预测模型的AUC为0.85，灵敏度为85.98%，特异度为71.74%，预测准确率为74.26%，优于未预先进行变量筛选的前进法Logistic回归模型。结论: 用引入注意力机制的LSTM和L1正则的Logistic回归筛选出的变量的预测效果较好，具有一定的临床价值。

关键词: 卒中, 预后, 预测, LSTM, Logistic模型

Abstract:

Objective: To select variables related to mortality risk of stroke patients in intensive care unit (ICU) through long short-term memory (LSTM) with attention mechanisms and Logistic regression with L1 norm, and to construct mortality risk prediction model based on conventional Logistic regression with important variables selected from the two models and to evaluate the model performance. Methods: Medical Information Mart for Intensive Care (MIMIC)-Ⅳ database was retrospectively analyzed and the patients who were primarily diagnosed with stroke were selected as study population. The outcome was defined as whether the patient died in hospital after admission. Candidate predictors included demogra-phic information, complications, laboratory tests and vital signs in the initial 48 h after ICU admission. The data were randomly divided into a training set and a test set for ten times at a ratio of 8 ∶2. In training sets, LSTM with attention mechanisms and Logistic regression with L1 norm were constructed to select important variables. In the test sets, the mean importance of variables of ten times was used as a reference to pick out the top 10 variables in each of the two models, and then these variables were included in conventional Logistic regression to build the final prediction model. Model evaluation was based on the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. And the model performance was compared with the forward Logistic regression model which hadn't conducted variable selection previously. Results: A total of 2 755 patients with 2 979 ICU admission records were included in the analysis, of which 526 recorded deaths. The AUC of Logistic regression model with L1 norm was statistically better than that of LSTM with attention mechanisms (0.819±0.031 vs. 0.760±0.018, P < 0.001). Age, blood glucose, and blood urea nitrogen were at the top ten important variables in both of the two models. AUC, sensitivity, specificity, and accuracy of Logistic regression models were 0.85, 85.98%, 71.74% and 74.26%, respectively. And the final prediction model was superior to forward Logistic regression model. Conclusion: The variables selected by Logistic regression with L1 norm and LSTM with attention mechanisms had good prediction performance, which showed important implications on the mortality prediction of stroke patients in ICU.

Key words: Stroke, Prognosis, Forecasting, LSTM, Logistic models

中图分类号:

R743.3

邓宇含,姜勇,王子尧,刘爽,汪雨欣,刘宝花. 基于长短期记忆网络和Logistic回归的重症监护病房脑卒中患者院内死亡风险预测[J]. 北京大学学报（医学版）, 2022, 54(3): 458-467.

Yu-han DENG,Yong JIANG,Zi-yao WANG,Shuang LIU,Yu-xin WANG,Bao-hua LIU. Long short-term memory and Logistic regression for mortality risk prediction of intensive care unit patients with stroke[J]. Journal of Peking University (Health Sciences), 2022, 54(3): 458-467.

图/表 8

图1

图2

表1

根据院内死亡情况分组的ICU脑卒中患者的变量特征"

Characteristic	Total (n=2 979)	Outcome
Characteristic	Total (n=2 979)	Death (n=526)	Survival (n=2 453)	P value
Age/years	69 (56, 80)	75 (64, 83)	67 (55, 79)	< 0.001
Gender				0.737
Male	1 532 (51.4)	274 (52.1)	1 258 (51.3)
Female	1 447 (48.6)	252 (47.9)	1 195 (48.7)
Ethnicity				< 0.001
White	1 784 (59.9)	251 (47.7)	1 533 (62.5)
Black American	306 (10.3)	61 (11.6)	245 (10.0)
Asian	112 (3.8)	23 (4.4)	89 (3.6)
Hispanic	111 (3.7)	15 (2.9)	96 (3.9)
Others/unknown	666 (22.4)	176 (33.5)	490 (20.0)
Stroke subtype				0.270
Ischemic stroke	1 185 (39.8)	198 (37.6)	987 (40.2)
Hemorrhagic stroke	1 794 (60.2)	328 (62.4)	1 466 (59.8)
AFIB				< 0.001
Yes	367 (12.3)	106 (20.2)	261 (10.6)
No	2 612 (87.7)	420 (79.8)	2 192 (89.4)
CHF				< 0.001
Yes	216 (7.3)	65 (12.4)	151 (6.2)
No	2 763 (92.7)	461 (87.6)	2 302 (93.8)
COPD				0.770
Yes	212 (7.1)	39 (7.4)	173 (7.1)
No	2 767 (92.9)	487 (92.6)	2 280 (92.9)
Diabetes				< 0.001
Yes	333 (11.2)	82 (15.6)	251 (10.2)
No	2 646 (88.8)	444 (84.4)	2 202 (89.8)
Hyperlipidemia				0.055
Yes	1 181 (39.6)	189 (35.9)	992 (40.4)
No	1 798 (60.4)	337 (64.1)	1 461 (59.6)
Hypertension				0.002
Yes	949 (31.9)	137 (26.0)	812 (33.1)
No	2 030 (68.1)	389 (74.0)	1 641 (66.9)
Liver disease				< 0.001
Yes	120 (4.0)	39 (7.4)	81 (3.3)
No	2 859 (96.0)	487 (92.6)	2 372 (96.7)
PVD				0.052
Yes	77 (2.6)	20 (3.8)	57 (2.3)
No	2 902 (97.4)	506 (96.2)	2 396 (97.7)
Rental disease				< 0.001
Yes	526 (17.7)	141 (26.8)	385 (15.7)
No	2 453 (82.3)	385 (73.2)	2 068 (84.3)
Respiratory failure				< 0.001
Yes	814 (27.3)	278 (52.9)	536 (21.9)
No	2 165 (72.7)	248 (47.1)	1 917 (78.1)
HR/(beats/min)	79.3 (70.5, 88.2)	84.8 (75.7, 94.5)	78.2 (69.5, 86.8)	< 0.001
Respiratory rate/(times/min)	18.6 (16.7, 20.9)	19.9 (17.7, 22.4)	18.4 (16.6, 20.5)	< 0.001
SpO₂/%	97.2 (96.0, 98.4)	98.0 (96.6, 99.0)	97.0 (95.9, 98.2)	< 0.001
MBP/mmHg	85.9 (77.7, 92.6)	83.9 (75.6, 90.0)	86.4 (78.1, 93.3)	< 0.001
DBP/mmHg	70.7 (62.5, 77.3)	68.6 (59.7, 75.0)	71.1 (63.2, 77.9)	< 0.001
SBP/mmHg	130.9 (120.6, 140.7)	130.9 (120.0, 140.0)	130.9 (120.7, 140.9)	0.286
PT/s	12.9 (12.1, 13.6)	13.3 (12.4, 14.2)	12.8 (12.0, 13.4)	< 0.001
INR	1.2 (1.1, 1.2)	1.2 (1.1, 1.3)	1.2 (1.1, 1.2)	< 0.001
RDW/%	13.9 (13.3, 14.7)	14.2 (13.6, 15.3)	13.8 (13.2, 14.6)	< 0.001
Hemoglobin/(g/dL)	11.8 (10.6, 12.9)	11.5 (10.3, 12.5)	11.8 (10.7, 12.9)	< 0.001
WBC/(×10⁹/L)	10.4 (8.7, 12.7)	11.8 (9.8, 15.0)	10.2 (8.6, 12.3)	< 0.001
Platelet count/(×10⁹/L)	207.6 (172.6, 248.0)	196.2 (157.0, 240.2)	209.9 (175.1, 249.9)	< 0.001
Hematocrit/%	35.5 (32.3, 38.5)	34.7 (31.3, 37.7)	36.7 (32.6, 38.6)	< 0.001
Glucose/(mg/dL)	127.4 (112.3, 147.2)	141.5 (124.5, 168.9)	124.8 (110.8, 142.5)	< 0.001
Anion gap/(mmol/L)	14.0 (12.6, 15.4)	14.4 (12.9, 16.2)	13.9 (12.6, 15.3)	< 0.001
Bicarbonate/(mmol/L)	23.2 (21.7, 24.9)	22.8 (20.8, 24.8)	23.3 (21.9, 24.9)	< 0.001
Creatinine/(mg/dL)	0.9 (0.7, 1.1)	1.0 (0.8, 1.3)	0.9 (0.7, 1.0)	< 0.001
Urea nitrogen/(mg/dL)	15.6 (12.2, 20.8)	18.8 (13.9, 26.4)	15.0 (11.9, 19.8)	< 0.001
Chloride/(mmol/L)	105.6 (103.1, 107.8)	106.9 (103.9, 110.8)	105.3 (103.0, 107.4)	< 0.001
Potassium/(mmol/L)	3.9 (3.7, 4.1)	3.9 (3.7, 4.2)	3.9 (3.7, 4.1)	0.011
Sodium/(mmol/L)	140.4 (138.5, 142.4)	141.5 (139.1, 145.2)	140.2 (138.4, 142.1)	< 0.001

表1

图3

图4

图5

表2

图6

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Variable	β	SE	Wald χ²	OR (95%CI)
Intercept	-8.07	1.06	58.50
Age	3.42	0.38	82.52	30.81 (14.71, 64.55)
Ethnicity (ref: White)
Black American	-0.08	0.18	0.21	1.11 (0.74, 1.69)
Asian	-0.19	0.29	0.44	1.00 (0.49, 2.05)
Hispanic	-0.01	0.24	0.01	1.19 (0.66, 2.15)
Others/unknown	0.48	0.14	12.38	1.96 (1.47, 2.60)
Hemoglobin (SD)	-1.08	0.61	3.11	0.34 (0.10, 1.13)
Glucose (mean)	3.33	0.56	35.01	27.95 (9.28, 84.24)
Anion gap (mean)	2.24	0.78	8.38	9.43 (2.06, 43.07)
Bicarbonate (mean)	-1.37	0.60	5.18	0.25 (0.08, 0.83)
Bicarbonate (SD)	0.77	0.48	2.56	2.17 (0.84, 5.59)
Urea nitrogen (SD)	-0.98	0.71	1.89	0.37 (0.09, 1.52)
Sodium (max)	5.59	0.67	69.05	268.61 (71.81, 1 000.00)
SpO₂ (mean)	3.72	1.55	5.80	41.37 (2.00, 855.38)
Heart rate (min)	0.54	0.59	0.81	1.71 (0.53, 5.49)
Hyperlipidemia (ref: no)	-0.24	0.07	13.83	0.62 (0.48, 0.80)
CHF (ref: no)	0.25	0.10	6.13	1.66 (1.11, 2.48)
Liver disease (ref: no)	0.50	0.13	15.90	2.73 (1.67, 4.47)
Respiratory failure (ref: no)	0.55	0.06	74.68	3.02 (2.35, 3.89)

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基于长短期记忆网络和Logistic回归的重症监护病房脑卒中患者院内死亡风险预测

Long short-term memory and Logistic regression for mortality risk prediction of intensive care unit patients with stroke

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