6.Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
Sang Won PARK ; Na Young YEO ; Seonguk KANG ; Taejun HA ; Tae-Hoon KIM ; DooHee LEE ; Dowon KIM ; Seheon CHOI ; Minkyu KIM ; DongHoon LEE ; DoHyeon KIM ; Woo Jin KIM ; Seung-Joon LEE ; Yeon-Jeong HEO ; Da Hye MOON ; Seon-Sook HAN ; Yoon KIM ; Hyun-Soo CHOI ; Dong Kyu OH ; Su Yeon LEE ; MiHyeon PARK ; Chae-Man LIM ; Jeongwon HEO ; On behalf of the Korean Sepsis Alliance (KSA) Investigators
Journal of Korean Medical Science 2024;39(5):e53-
Background:
Worldwide, sepsis is the leading cause of death in hospitals. If mortality rates in patients with sepsis can be predicted early, medical resources can be allocated efficiently. We constructed machine learning (ML) models to predict the mortality of patients with sepsis in a hospital emergency department.
Methods:
This study prospectively collected nationwide data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Patients were enrolled from 19 hospitals between September 2019 and December 2020. For acquired data from 3,657 survivors and 1,455 deaths, six ML models (logistic regression, support vector machine, random forest, extreme gradient boosting [XGBoost], light gradient boosting machine, and categorical boosting [CatBoost]) were constructed using fivefold cross-validation to predict mortality. Through these models, 44 clinical variables measured on the day of admission were compared with six sequential organ failure assessment (SOFA) components (PaO 2 /FIO 2 [PF], platelets (PLT), bilirubin, cardiovascular, Glasgow Coma Scale score, and creatinine).The confidence interval (CI) was obtained by performing 10,000 repeated measurements via random sampling of the test dataset. All results were explained and interpreted using Shapley’s additive explanations (SHAP).
Results:
Of the 5,112 participants, CatBoost exhibited the highest area under the curve (AUC) of 0.800 (95% CI, 0.756–0.840) using clinical variables. Using the SOFA components for the same patient, XGBoost exhibited the highest AUC of 0.678 (95% CI, 0.626–0.730). As interpreted by SHAP, albumin, lactate, blood urea nitrogen, and international normalization ratio were determined to significantly affect the results. Additionally, PF and PLTs in the SOFA component significantly influenced the prediction results.
Conclusion
Newly established ML-based models achieved good prediction of mortality in patients with sepsis. Using several clinical variables acquired at the baseline can provide more accurate results for early predictions than using SOFA components. Additionally, the impact of each variable was identified.
7.Siewert–Kartagener’s syndrome in a dog
Rankyung JUNG ; Jihye CHOI ; Hyeona BAE ; Dong-In JUNG ; Kyoung-Oh CHO ; DoHyeon YU
Journal of Veterinary Science 2023;24(4):e57-
Siewert–Kartagener’s syndrome, a type of primary ciliary dyskinesia, is a complex disease comprising situs inversus, rhinosinusitis, and bronchiectasis. Situs inversus totalis is a condition in which all organs in the thoracic and abdominal cavities are reversed.Furthermore, primary ciliary dyskinesia, an autosomal genetic disease, may coexist with situs inversus totalis. Reports on Siewert–Kartagener’s syndrome in veterinary medicine are limited. We report a rare case of primary ciliary dyskinesia with Siewert-Kartagener’s syndrome in a dog, concurrently infected with canine distemper virus and type-2 adenovirus.This case highlights that situs inversus totalis can cause primary ciliary dyskinesia, and concurrent infections are possible.
8.Two Clinical Cases of Feline Hemoplasmosis in Korea
Young Ju KIM ; Hyeona BAE ; Sun Woo SHIN ; ARom CHO ; Yeseul JEON ; Tae-Sung HWANG ; Dong-In JUNG ; Dae Young KIM ; Jun-Gu KANG ; DoHyeon YU
The Korean Journal of Parasitology 2022;60(2):127-131
Feline hemotropic mycoplasmosis (hemoplasmosis) is an infection of the red blood cells caused by the Mycoplasma haemofelis (Mhf), Candidatus Mycoplasma haemominutum (CMhm), and Candidatus Mycoplasma turicensis (CMt). The existence of Mhf, CMhm, and CMt has been demonstrated in feral cats in Korea using molecular methods, but no clinical cases have yet been reported. This study reports 2 clinical cases of hemotropic mycoplasmosis caused by CMhm and CMt in 2 anemic cats. The first case was a client-owned intact female domestic shorthair cat that presented with fever, pale mucous membranes, and normocytic normochromic non-regenerative anemia. Prior to referral, an immunosuppressive prednisolone dose was administered at the local veterinary clinic for 1 month. The cat was diagnosed with high-grade alimentary lymphoma. Organisms were found on the surface of the red blood cells on blood smear examination. The second case was of a rescued cat that presented with dehydration and fever. The cat had normocytic normochromic non-regenerative anemia. Necropsy revealed concurrent feline infectious peritonitis. Polymerase chain reaction assay targeting 16S rRNA revealed CMhm infection in case 1 and dual infection of CMhm and CMt in case 2. Normocytic normochromic non-regenerative anemia was observed in both cats before and during the management of the systemic inflammation. This is the first clinical case report in Korea to demonstrate CMhm and CMt infections in symptomatic cats.
9.A comparison of traditional and quantitative analysis of acid-base and electrolyte imbalance in 87 cats
Korean Journal of Veterinary Research 2021;61(4):e40-
Acid–base disorder is a common problem in veterinary emergency and critical care. Traditional methods, as well as the Stewart method based on strong ion difference concepts and the Fencl–Stewart method, can be used to analyze the underlying causes. On the other hand, there are insufficient comparative study data on these methods in cats. From 2018 to 2020, 327 acid–base analysis data were collected from 69 sick and 18 healthy cats. The three most well-known methods (traditional method, Stewart method, and Fencl–Stewart method) were used to analyze the acid–base status. The frequency of acid–base imbalances and the degree of variation according to the disease were also evaluated. In traditional acid–base analysis, 5/69 cats (7.2%) showed a normal acid–base status and 23.2% and 40.6% of the mixed and straightforward disorders, respectively. The Fencl–Stewart method showed changes in both the acidotic and alkalotic processes in 64/69 (92.8%), whereas all cats showed an abnormal status in the Fencl–Stewart method (semiquantitative approach). Different acid–base imbalances were identified according to the analysis method. These findings from the disease categories are anticipated to assist in analyzing the underlying causes of acid–base imbalance and developing the appropriate treatment.
10.CD3+/CD4+/CD5+/CD8+/CD21+/CD34-/CD45-/CD79a-/TCRαβ+/TCRγδ-/MHCII+ T-zone lymphoma in a dog with generalized lymphadenopathy: a case report
Sun Woo SHIN ; Yu jin LIM ; Hyeona BAE ; Jihu KIM ; ARom CHO ; Jinho PARK ; Dongbin LEE ; Dong-In JUNG ; Sang-ki KIM ; DoHyeon YU
Korean Journal of Veterinary Research 2021;61(3):e21-
Canine T-zone lymphoma (TZL) is a mature T-cell lymphoma in dogs. The diagnosis and sub-classification are impossible without biopsy or immunophenotyping by flow cytometry. An 11-year-old, spayed, female Golden Retriever presented with lymph node enlargement. Clinical examination was consistent with canine multicentric lymphoma. However, immunophenotyping revealed positive for CD3, CD4, CD5, CD8, CD21, TCRαβ, and MHCII but negative for CD34, CD45, CD79a, and TCRγδ. Histopathology revealed lymphocytes expanding to the cortex-preserving architecture and thinning of the nodal capsule, and CD3 positive but PAX-5 negative. Owing to the indolent nature of TZL, careful monitoring approach without clinical intervention was utilized.

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