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
邓宇含1,姜勇2,3,王子尧1,刘爽1,汪雨欣1,刘宝花1,*()
Yu-han DENG1,Yong JIANG2,3,Zi-yao WANG1,Shuang LIU1,Yu-xin WANG1,Bao-hua LIU1,*()
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。
中图分类号:
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