Prediction of Visual Acuity in Patients With Microbial Keratitis.
Prediction of Visual Acuity in Patients With Microbial Keratitis.
复制标题
微生物性角膜炎患者视力的预测。
DOI：
10.1097/ico.0000000000003129
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发表时间：
2023
期刊：
影响因子：
2.8
通讯作者：
Singh,Karandeep
中科院分区：
文献类型：
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作者：
Woodward,MariaA;Niziol,LeslieM;Ballouz,Dena;Lu,Ming-Chen;Kang,Linda;Thibodeau,Alexa;Singh,Karandeep
目的：本研究的目的是根据最初的临床眼科就诊数据预测微生物角膜炎（MK）患者就诊90天后的视力（VA）。方法：在2012年8月至2021年2月的电子健康记录中识别MK患者。随机森林（RF）模型预测90天VA< 20/40[视力损害（VI）]。评估的预测因素包括年龄、性别、初始VA和报告时记录的信息。模型诊断报告曲线下面积（AUC）、误分类率、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）的95%置信区间（ci）。结果：共发现1791例患者。受影响或更严重的眼的logMAR VA平均为0.86 （Snellen等效和标准差= 20/144±12.6线），VI患者为43.6%。90天随访时，26.9%的患者受影响或更严重的眼存在VI。预测90天VI的RF模型AUC为95%(CI: 93%-97%)，误分类率为9%（7%-12%）。灵敏度86%(80% ~ 91%)，特异度92%(89% ~ 95%),PPV 81%(74% ~ 86%), NPV 95%（92% ~ 97%）。年龄越大，表现较差的VA，以及提及较多的“穿透性角膜移植术”和“创可贴隐形眼镜”与90天VI的可能性增加相关，而提及较多的“安静”与90天VI的可能性降低相关。结论：RF模型在预测90天VI方面具有良好的敏感性和特异性，可以指导临床医生了解MK患者视力不良的风险。
Purpose:The purpose of this study was to predict visual acuity (VA) 90 days after presentation for patients with microbial keratitis (MK) from data at the initial clinical ophthalmic encounter.Methods:Patients with MK were identified in the electronic health record between August 2012 and February 2021. Random forest (RF) models were used to predict 90-day VA< 20/40 [visual impairment (VI)]. Predictors evaluated included age, sex, initial VA, and information documented in notes at presentation. Model diagnostics are reported with 95% confidence intervals (CIs) for area under the curve (AUC), misclassification rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results:One thousand seven hundred ninety-one patients were identified. The presenting logMAR VA was on average 0.86 (Snellen equivalent and standard deviation= 20/144±12.6 lines) in the affected or worse eye, and 43.6% with VI. VI at 90-day follow-up was present in the affected eye or worse eye for 26.9% of patients. The RF model for predicting 90-day VI had an AUC of 95%(CI: 93%–97%) and a misclassification rate of 9%(7%–12%). The percent sensitivity, specificity, PPV, and NPV were 86%(80%–91%), 92%(89%–95%), 81%(74%–86%), and 95%(92%–97%), respectively. Older age, worse presenting VA, and more mentions of “penetrating keratoplasty” and “bandage contact lens” were associated with increased probability of 90-day VI, whereas more mentions of “quiet” were associated with decreased probability of 90-day VI.Conclusions:RF modeling yielded good sensitivity and specificity to predict VI at 90 days which could guide clinicians about the risk of poor vision outcomes for patients with MK.