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    小脑出血短期死亡风险预测:四种机器学习模型评估及SII指标的显著影响

    Prediction of short-term mortality risk in cerebellar hemorrhage: Evaluation of four machine learning models and the significant impact of SII

    • 摘要: 目的 构建机器学习模型预测小脑出血患者短期死亡风险。方法 基于203例自发性小脑出血患者数据,运用logistic回归、随机森林、极端梯度提升(XGBoost)和表格先验数据拟合网络(TabPFN)4种模型,经LASSO回归筛选特征后开发并验证模型。利用ROC曲线、准确率等相关指标对机器学习模型的性能进行综合评价,利用SHAP图阐明模型内变量的重要性,选择最优模型。结果 自发性小脑出血患者短期死亡率为27.7%(56/203)。TabPFN模型预测效能最佳(训练集AUC: 0.959, 95%CI:0.926~0.983;测试集AUC: 0.815, 95%CI:0.670~0.930)。SHAP分析显示,模型内关键变量依次为:入院格拉斯哥昏迷评分(GCS)评分、系统性免疫炎症指数(SII)、血肿最大横截面与颅后窝面积比、是否伴脑干受压与出血破入脑室。结论 低GCS评分、高SII、高血肿最大横截面与颅后窝面积比、出血破入脑室是小脑出血患者短期死亡的独立危险因素。TabPFN机器学习模型可用于预测自发性小脑出血短期死亡,其中入院GCS评分及SII预测价值较大。

       

      Abstract: Objective To construct machine learning models for predicting the short-term mortality risk in patients with cerebellar hemorrhage. Methods Data were collected from 203 patients with spontaneous cerebellar hemorrhage and subjected to LASSO regression for screening risk factors. Then, logistic regression, random forest, extreme gradient boosting (XGBoost) and TabPFN models were applied for development and validation. The performance of the models was comprehensively evaluated using ROC curves, accuracy, and other related metrics, and the SHAP plot was used to explain the importance of variables within the model in order to select the optimal model. Results The short-term mortality rate in patients with spontaneous cerebellar hemorrhage was 27.7% (56/203). The TabPFN model showed the optimal prediction performance (Training AUC: 0.959, 95%CI: 0.926-0.983; Testing AUC: 0.815, 95%CI: 0.670-0.930). SHAP analysis revealed that the key variables in the model were admission GCS score, systemic immune-inflammation index (SII), the ratio of maximum hematoma cross-section to posterior fossa area, presence of brainstem compression, and intraventricular hemorrhage. Conclusions Low GCS score, high SII, high ratio of hematoma cross-section to posterior fossa area, and intraventricular hemorrhage are independent risk factors for short-term mortality in patients with cerebellar hemorrhage. The TabPFN machine learning model can be used to predict short-term mortality in patients with spontaneous cerebellar hemorrhage, with admission GCS score and SII being the most significant predictors.

       

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