arXiv:2508.06023cs.LG2025-08被引 1

根据患者恢复进程,动态判断何时使用血流动力学数据提升预后预测。

Stepwise Fine and Gray: Subject-Specific Variable Selection Shows When Hemodynamic Data Improves Prognostication of Comatose Post-Cardiac Arrest Patients

  • 分阶段建模:先用基础信息,再动态评估血流动力学数据的价值
  • 在2278名患者中,对觉醒、撤除治疗和死亡的预测准确率显著提升
  • 适合重症监护中需实时调整预后的临床决策场景

心脏骤停后昏迷患者的预后评估是重症监护中的关键挑战,直接影响临床决策。临床信息分两个阶段采集:骤停后立即获取时间不变的基线特征(如人口学、心脏骤停特征);入院后逐步收集时间可变的血流动力学数据(如血压、升压药剂量)。本文提出一种新型分步动态竞争风险模型,自动判断何时利用基线特征(第一阶段)和何时引入随时间变化的血流动力学数据(第二阶段)。模型发现部分患者在第二阶段使用血流动力学数据能显著改善预后预测,并揭示随着数据积累,其重要性动态变化。该方法扩展了标准Fine and Gray模型,引入神经网络以灵活捕捉复杂非线性关系。在2278例回顾性队列上验证,对觉醒、撤除生命支持治疗和死亡三种竞争结局均表现出稳健的判别性能。该框架可推广至更多阶段的数据采集场景,适用于需要动态评估新特征价值的预测任务。

原文摘要 · Abstract (English)

Prognostication for comatose post-cardiac arrest patients is a critical challenge that directly impacts clinical decision-making in the ICU. Clinical information that informs prognostication is collected serially over time. Shortly after cardiac arrest, various time-invariant baseline features are collected (e.g., demographics, cardiac arrest characteristics). After ICU admission, additional features are gathered, including time-varying hemodynamic data (e.g., blood pressure, doses of vasopressor medications). We view these as two phases in which we collect new features. In this study, we propose a novel stepwise dynamic competing risks model that improves the prediction of neurological outcomes by automatically determining when to take advantage of time-invariant features (first phase) and time-varying features (second phase). Notably, our model finds patients for whom this second phase (time-varying hemodynamic) information is beneficial for prognostication and also when this information is beneficial (as we collect more hemodynamic data for a patient over time, how important these data are for prognostication varies). Our approach extends the standard Fine and Gray model to explicitly model the two phases and to incorporate neural networks to flexibly capture complex nonlinear feature relationships. Evaluated on a retrospective cohort of 2,278 comatose post-arrest patients, our model demonstrates robust discriminative performance for the competing outcomes of awakening, withdrawal of life-sustaining therapy, and death despite maximal support. Our approach generalizes to more than two phases in which new features are collected and could be used in other dynamic prediction tasks, where it may be helpful to know when and for whom newly collected features significantly improve prediction.

预后预测动态建模重症监护

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