Unsupervised learning of early post-arrest brain injury phenotypes
Unsupervised learning of early post-arrest brain injury phenotypes
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DOI：
10.1016/j.resuscitation.2020.05.051
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发表时间：
2020-08-01
期刊：
影响因子：
6.5
通讯作者：
Callaway, Clifton W.
中科院分区：
文献类型：
--
作者：
Elmer, Jonathan;Coppler, Patrick J.;Callaway, Clifton W.
简介：当试验没有适当地针对实验干预时，试验可能是中立的。我们推测，对早期缺氧缺血性脑损伤的多模式评估将确定可能受益于治疗干预的表型。方法：我们进行了一项回顾性研究，包括 2011 年至 2019 年期间在 26 家医院之一的 126 家紧急医疗服务机构或院内心脏骤停 (OHCA) 中复苏的昏迷患者。所有患者最终都被转运到一个三级中心用于护理，包括标准化初始神经系统检查、脑成像和脑电图检查；目标温度管理（TTM）；血流动力学优化目标平均动脉压 (MAP) >80 mmHg；以及，冠状动脉造影用于临床怀疑急性冠状动脉综合征。我们使用无监督学习来识别入院神经诊断定义的脑损伤表型。我们在预测恢复的模型中测试了表型与 TTM、血流动力学管理和心导管插入术之间的相互作用。结果：我们纳入了 1086 名平均 (SD) 年龄为 58 (17) 岁的患者，其中 955 名 (88%) 从 OHCA 中复苏。出院存活率为 27%，其中 248 人 (23%) 出院时脑功能类别 (CPC) 1-3 级。我们确定了 5 个簇，定义了不同的脑损伤表型，每个簇占队列的 14% 至 30%，出院 CPC 1-3 占 59% 至
Introduction: Trials may be neutral when they do not appropriately target the experimental intervention. We speculated multimodality assessment of early hypoxic-ischemic brain injury would identify phenotypes likely to benefit from therapeutic interventions.Methods: We performed a retrospective study including comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA) by one of 126 emergency medical services or in-hospital arrest at one of 26 hospitals from 2011 to 2019. All patients were ultimately transported to a single tertiary center for care including standardized initial neurological examination, brain imaging and electroencephalography; targeted temperature management (TTM); hemodynamic optimization targeting mean arterial pressure (MAP) >80 mmHg; and, coronary angiography for clinical suspicion for acute coronary syndrome. We used unsupervised learning to identify brain injury phenotypes defined by admission neurodiagnostics. We tested for interactions between phenotype and TTM, hemodynamic management and cardiac catheterization in models predicting recovery.Results: We included 1086 patients with mean (SD) age 58 (17) years of whom 955 (88%) were resuscitated from OHCA. Survival to hospital discharge was 27%, and 248 (23%) were discharged with Cerebral Performance Category (CPC) 1-3. We identified 5 clusters defining distinct brain injury phenotypes, each comprising 14% to 30% of the cohort with discharge CPC 1-3 in 59% to