用专家混合模型实时预测重症患者谵妄与昏迷，提升早期预警能力。
MANDARIN: Mixture-of-Experts Framework for Dynamic Delirium and Coma Prediction in ICU Patients: Development and Validation of an Acute Brain Dysfunction Prediction Model
- 采用多分支专家网络融合动态与静态数据，实现12-72小时脑功能状态预测。
- 外部验证和前瞻性测试中，谵妄预测AUROC达75.5%和82.0%，昏迷预测达87.3%和93.4%。
- 适合临床重症监护中持续脑功能监测，辅助医生及时干预。
急性脑功能障碍（ABD）是重症监护病房（ICU）常见且严重的并发症，表现为谵妄或昏迷，导致住院时间延长、死亡率上升及认知衰退。传统评估工具如格拉斯哥昏迷量表（GCS）、混淆评估法（CAM）和瑞金躁动镇静量表（RASS）依赖间断评估，存在延迟与不一致问题。本研究提出MANDARIN（用于动态谵妄与昏迷预测的专家混合框架），一个150万参数的混合专家神经网络，用于实时预测ICU患者未来12至72小时的脑功能状态。模型整合了来自2008–2019年两家医院共92,734名患者（132,997次入院）的数据，使用佛罗里达大学健康数据库（UFH）、电子重症监护协作研究数据库（eICU）和医疗信息集市重症监护（MIMIC-IV）数据集进行训练，并在来自15家医院的11,719名患者（14,519次入院）的外部数据及2021–2024年单家医院304名患者（503次入院）的前瞻性数据上验证。结果表明，该模型在外部验证和前瞻性队列中均显著优于基准神经评估评分（如GCS、CAM、RASS）：谵妄预测外部验证的AUROC为75.5%（95%CI: 74.2%-76.8%），前瞻性为82.0%（95%CI: 74.8%-89.2%）；昏迷预测外部验证为87.3%（95%CI: 85.9%-89.0%），前瞻性为93.4%（95%CI: 88.5%-97.9%），领先12小时。该工具具备辅助临床决策的潜力，可实现对ICU患者脑功能状态的连续监测。
原文摘要 · Abstract (English)
Acute brain dysfunction (ABD) is a common, severe ICU complication, presenting as delirium or coma and leading to prolonged stays, increased mortality, and cognitive decline. Traditional screening tools like the Glasgow Coma Scale (GCS), Confusion Assessment Method (CAM), and Richmond Agitation-Sedation Scale (RASS) rely on intermittent assessments, causing delays and inconsistencies. In this study, we propose MANDARIN (Mixture-of-Experts Framework for Dynamic Delirium and Coma Prediction in ICU Patients), a 1.5M-parameter mixture-of-experts neural network to predict ABD in real-time among ICU patients. The model integrates temporal and static data from the ICU to predict the brain status in the next 12 to 72 hours, using a multi-branch approach to account for current brain status. The MANDARIN model was trained on data from 92,734 patients (132,997 ICU admissions) from 2 hospitals between 2008-2019 and validated externally on data from 11,719 patients (14,519 ICU admissions) from 15 hospitals and prospectively on data from 304 patients (503 ICU admissions) from one hospital in 2021-2024. Three datasets were used: the University of Florida Health (UFH) dataset, the electronic ICU Collaborative Research Database (eICU), and the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. MANDARIN significantly outperforms the baseline neurological assessment scores (GCS, CAM, and RASS) for delirium prediction in both external (AUROC 75.5% CI: 74.2%-76.8% vs 68.3% CI: 66.9%-69.5%) and prospective (AUROC 82.0% CI: 74.8%-89.2% vs 72.7% CI: 65.5%-81.0%) cohorts, as well as for coma prediction (external AUROC 87.3% CI: 85.9%-89.0% vs 72.8% CI: 70.6%-74.9%, and prospective AUROC 93.4% CI: 88.5%-97.9% vs 67.7% CI: 57.7%-76.8%) with a 12-hour lead time. This tool has the potential to assist clinicians in decision-making by continuously monitoring the brain status of patients in the ICU.
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