单位:[1]Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.浙江大学医学院附属第一医院[2]Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.[3]Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.外科学系创伤外科华中科技大学同济医学院附属同济医院[4]Department of Critical Care Medicine, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.[5]Department of FSTC Clinic of The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.浙江大学医学院附属第一医院
Although current guidelines didn't support the routine use of furosemide in oliguric acute kidney injury (AKI) management, some patients may benefit from furosemide administration at an early stage. We aimed to develop an explainable machine learning (ML) model to differentiate between furosemide-responsive (FR) and furosemide-unresponsive (FU) oliguric AKI.From Medical Information Mart for Intensive Care-IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD), oliguric AKI patients with urine output (UO) < 0.5 ml/kg/h for the first 6 h after ICU admission and furosemide infusion ≥ 40 mg in the following 6 h were retrospectively selected. The MIMIC-IV cohort was used in training a XGBoost model to predict UO > 0.65 ml/kg/h during 6-24 h succeeding the initial 6 h for assessing oliguria, and it was validated in the eICU-CRD cohort. We compared the predictive performance of the XGBoost model with the traditional logistic regression and other ML models.6897 patients were included in the MIMIC-IV training cohort, with 2235 patients in the eICU-CRD validation cohort. The XGBoost model showed an AUC of 0.97 (95% CI: 0.96-0.98) for differentiating FR and FU oliguric AKI. It outperformed the logistic regression and other ML models in correctly predicting furosemide diuretic response, achieved 92.43% sensitivity (95% CI: 90.88-93.73%) and 95.12% specificity (95% CI: 93.51-96.3%).A boosted ensemble algorithm can be used to accurately differentiate between patients who would and would not respond to furosemide in oliguric AKI. By making the model explainable, clinicians would be able to better understand the reasoning behind the prediction outcome and make individualized treatment.
基金:
This work was supported by the Project funded by China
Postdoctoral Science Foundation (2020M682422) and
National Natural Science Foundation of China (82000479).
第一作者单位:[1]Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.[*1]Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang Province, China
通讯作者:
通讯机构:[1]Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.[2]Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.[5]Department of FSTC Clinic of The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.[*1]Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang Province, China[*2]Department of FSTC Clinic of The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang Province, China[*3]Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, China
推荐引用方式(GB/T 7714):
Jiang Meng,Pan Chun-Qiu,Li Jian,et al.Explainable machine learning model for predicting furosemide responsiveness in patients with oliguric acute kidney injury[J].RENAL FAILURE.2023,45(1):2151468.doi:10.1080/0886022X.2022.2151468.
APA:
Jiang Meng,Pan Chun-Qiu,Li Jian,Xu Li-Gang&Li Chang-Li.(2023).Explainable machine learning model for predicting furosemide responsiveness in patients with oliguric acute kidney injury.RENAL FAILURE,45,(1)
MLA:
Jiang Meng,et al."Explainable machine learning model for predicting furosemide responsiveness in patients with oliguric acute kidney injury".RENAL FAILURE 45..1(2023)