$$\newcommand{\bra}[1]{\left<#1\right|}\newcommand{\ket}[1]{\left|#1\right>}\newcommand{\bk}[2]{\left<#1\middle|#2\right>}\newcommand{\bke}[3]{\left<#1\middle|#2\middle|#3\right>}$$
INFORMAÇÕES SOBRE DIREITOS AUTORAIS


As obras disponibilizadas nesta Biblioteca Digital foram publicadas sob expressa autorização dos respectivos autores, em conformidade com a Lei 9610/98.

A consulta aos textos, permitida por seus respectivos autores, é livre, bem como a impressão de trechos ou de um exemplar completo exclusivamente para uso próprio. Não são permitidas a impressão e a reprodução de obras completas com qualquer outra finalidade que não o uso próprio de quem imprime.

A reprodução de pequenos trechos, na forma de citações em trabalhos de terceiros que não o próprio autor do texto consultado,é permitida, na medida justificada para a compreeensão da citação e mediante a informação, junto à citação, do nome do autor do texto original, bem como da fonte da pesquisa.

A violação de direitos autorais é passível de sanções civis e penais.
Coleção Digital

Avançada


Estatísticas | Formato DC|



Título: PREDICTING THE ACQUISITION OF RESISTANT PATHOGENS IN ICUS USING MACHINE LEARNING TECHNIQUES
Instituição: PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO - PUC-RIO
Autor(es): LEILA FIGUEIREDO DANTAS

Colaborador(es):  SILVIO HAMACHER - Orientador
FERNANDO AUGUSTO BOZZA - Coorientador
Número do Conteúdo: 51384
Catalogação:  01/02/2021 Idioma(s):  ENGLISH - UNITED STATES

Tipo:  TEXT Subtipo:  THESIS
Natureza:  SCHOLARLY PUBLICATION
Nota:  Todos os dados constantes dos documentos são de inteira responsabilidade de seus autores. Os dados utilizados nas descrições dos documentos estão em conformidade com os sistemas da administração da PUC-Rio.
Referência [pt]:  https://www.maxwell.vrac.puc-rio.br/colecao.php?strSecao=resultado&nrSeq=51384@1
Referência [en]:  https://www.maxwell.vrac.puc-rio.br/colecao.php?strSecao=resultado&nrSeq=51384@2
Referência DOI:  https://doi.org/10.17771/PUCRio.acad.51384

Resumo:
Infections by Carbapenem-Resistant Gram-negative bacteria (CR-GNB) are among the most significant contemporary health concerns, especially in intensive care units (ICUs), and may be associated with increased hospitalization time, morbidity, costs, and mortality. This thesis aims to develop a comprehensive and systematic approach applying machine-learning techniques to build models to predict the CR-GNB acquisition in ICUs from Brazilian hospitals. We proposed screening models to detect ICU patients who do not need to be tested and a risk model that estimates ICU patients probability of acquiring CR-GNB. We applied feature selection methods, machine-learning techniques, and balancing strategies to build and compare the models. The performance criteria chosen to evaluate the models were Negative Predictive Value (NPV) and Matthews Correlation Coefficient (MCC) for the screening model and Brier score and calibration curves for the CR-GNB acquisition risk model. Friedman s statistic and Nemenyi post hoc tests are used to test the significance of differences among techniques. Information gain method and association rules mining assess the importance and strength among features. Our database gathers the patients, antibiotic, and microbiology data from five Brazilian hospitals from May 8th, 2017 to August 31st, 2019, involving hospitalized patients in 24 adult ICUs. Information from the laboratory was used to identify all patients with a positive or negative test for carbapenem-resistant GNB, A. baumannii, P. aeruginosa, or Enterobacteriaceae. We have a total of 539 positive and 7,462 negative tests, resulting in 3,604 patients with at least one exam after 48 hours hospitalized. We proposed to the hospital s decision-maker two screening models. The random forest s model would reduce approximately 39 percent of the unnecessary tests and correctly predict 92 percent of positives. The Neural Network model avoids unnecessary tests in 64 percent of the cases, but 24 percent of positive tests are misclassified as negatives. Our results show that the sampling, SMOTEBagging, and UnderBagging approaches obtain better results. The linear techniques such as Logistic Regression with regularization give a relatively good performance and are more interpretable; they are not significantly different from the more complex classifiers. For the acquisition risk model, the Nearest Shrunken Centroids is the best model with a Brier score of 0.152 and a calibration belt acceptable. We developed an external validation of 624 patients from two other hospitals in the same network, finding good Brier score (0.128 and 0.079) values in both. The antibiotic and invasive procedures used, especially mechanical ventilation, are the most important attributes for the colonization or infection of CR-GNB. The predictive models can help avoid screening tests and inappropriate treatment in patients at low risk. Infection control policies can be established to control these bacteria s spread. Identifying patients who do not need to be tested decreases hospital costs and laboratory waiting times. We concluded that our models present good performance and seem sufficiently reliable to predict a patient with these pathogens. These predictive models can be included in the hospital system. The proposed methodology can be replicated in different healthcare settings.

Descrição Arquivo
COMPLETE  PDF
Logo maxwell Agora você pode usar seu login do SAU no Maxwell!!
Fechar Janela



* Esqueceu a senha:
Senha SAU, clique aqui
Senha Maxwell, clique aqui