Abdominal physical examinations in early stages benefit critically ill patients without primary gastrointestinal diseases: a retrospective cohort study.
| Autor: | Cui X; Department of Intensive Care Units, Peking University Third Hospital, Beijing, China., Shi Y; School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, China., He X; Department of Intensive Care Units, Peking University Third Hospital, Beijing, China., Zhang M; School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, China., Zhang H; Department of Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China., Yang J; School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, China., Leng Y; Department of Intensive Care Units, Peking University Third Hospital, Beijing, China. |
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| Jazyk: | angličtina |
| Zdroj: | Frontiers in medicine [Front Med (Lausanne)] 2024 Apr 09; Vol. 11, pp. 1338061. Date of Electronic Publication: 2024 Apr 09 (Print Publication: 2024). |
| DOI: | 10.3389/fmed.2024.1338061 |
| Abstrakt: | Background: Gastrointestinal (GI) function is critical for patients in intensive care units (ICUs). Whether and how much critically ill patients without GI primary diseases benefit from abdominal physical examinations remains unknown. No evidence from big data supports its possible additive value in outcome prediction. Methods: We performed a big data analysis to confirm the value of abdominal physical examinations in ICU patients without GI primary diseases. Patients were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database and classified into two groups depending on whether they received abdominal palpation and auscultation. The primary outcome was the 28-day mortality. Statistical approaches included Cox regression, propensity score matching, and inverse probability of treatment weighting. Then, the abdominal physical examination group was randomly divided into the training and testing cohorts in an 8:2 ratio. And patients with GI primary diseases were selected as the validation group. Several machine learning algorithms, including Random Forest, Gradient Boosting Decision Tree, Adaboost, Extra Trees, Bagging, and Multi-Layer Perceptron, were used to develop in-hospital mortality predictive models. Results: Abdominal physical examinations were performed in 868 (2.63%) of 33,007 patients without primary GI diseases. A significant benefit in terms of 28-day mortality was observed among the abdominal physical examination group (HR 0.75, 95% CI 0.56-0.99; p = 0.043), and a higher examination frequency was associated with improved outcomes (HR 0.62, 95%CI 0.40-0.98; p = 0.042). Machine learning studies further revealed that abdominal physical examinations were valuable in predicting in-hospital mortality. Considering both model performance and storage space, the Multi-Layer Perceptron model performed the best in predicting mortality (AUC = 0.9548 in the testing set and AUC = 0.9833 in the validation set). Conclusion: Conducting abdominal physical examinations improves outcomes in critically ill patients without GI primary diseases. The results can be used to predict in-hospital mortality using machine learning algorithms. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Cui, Shi, He, Zhang, Zhang, Yang and Leng.) |
| Databáze: | MEDLINE |
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