1.Explainable Machine Learning Model for Predicting Prognosis in Patients with Malignant Tumors Complicated by Acute Respiratory Failure: Based on the eICU Collaborative Research Database in the United States
Zihan NAN ; Linan HAN ; Suwei LI ; Ziyi ZHU ; Qinqin ZHU ; Yan DUAN ; Xiaoting WANG ; Lixia LIU
Medical Journal of Peking Union Medical College Hospital 2026;17(1):98-108
To develop and validate a model for predicting intensive care unit (ICU) mortality risk in patients with malignant tumors complicated by acute respiratory failure (ARF) based on an explainable machine learning framework. Clinical data of patients with malignant tumors and ARF were extracted from the eICU Collaborative Research Database in the United States, including demographic characteristics, comorbidities, vital signs, laboratory test indicators, and major interventions within the first 24 hours after ICU admission.The study outcome was ICU death.Enrolled patients were randomly divided into a training set and a validation set at a ratio of 7:3.Predictor variables were selected using least absolute shrinkage and selection operator (LASSO) regression.Five machine learning algorithms-extreme gradient boosting (XGBoost), support vector machine (SVM), Logistic regression, multilayer perceptron (MLP), and C5.0 Decision Tree-were employed to construct predictive models.Model performance was evaluated based on the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and other metrics.The optimal model was further interpreted using the Shapley additive explanations (SHAP) algorithm. A total of 3196 patients with malignant tumors complicated by ARF were included.The training set comprised 2, 261 patients and the validation set 935 patients; 683 patients died during ICU stay, while 2513 survived.LASSO regression ultimately selected 12 variables closely associated with patient ICU outcomes, including sepsis comorbidity, use of vasoactive drugs, and within the first 24 hours after ICU admission: minimum mean arterial pressure, maximum heart rate, maximum respiratory rate, minimum oxygen saturation, minimum serum bicarbonate, minimum blood urea nitrogen, maximum white blood cell count, maximum mean corpuscular volume, maximum serum potassium, and maximum blood glucose.After model evaluation, the XGBoost model demonstrated the best performance.The AUCs for predicting ICU mortality risk in the training and validation sets were 0.940 and 0.763, respectively; accuracy was 88.3% and 81.2%;sensitivity was 98.5% and 95.9%.Its predictive performance also remained optimal in sensitivity analyses.SHAP analysis indicated that the top five variables contributing to the model's predictions were minimum oxygen saturation, minimum serum bicarbonate, minimum mean arterial pressure, use of vasoactive drugs, and maximum white blood cell count. This study successfully developed a mortality risk prediction model for ICU patients with malignant tumors complicated by ARF based on a large-scale dataset and performed explainability analysis.The model aids clinicians in early identification of high-risk patients and implementing individualized interventions.
2.A preliminary study on horizontal sound localization in patients with unilateral sudden hearing loss during the acute phase
Mengyuan ZHU ; Xiaolin HE ; Jiaying LI ; Xing WANG ; Hongping DING ; Linan DIAO ; Xin FU ; Jiaxing LIU ; Zihui ZHAO ; Ningyu WANG ; Juan ZHANG
Chinese Archives of Otolaryngology-Head and Neck Surgery 2025;32(5):288-293
OBJECTIVE To preliminarily assess the horizontal sound localization and its influencing factors in patients with unilateral sudden sensorineural hearing loss during the acute phase.METHODS The azimuth discrimination test and azimuth identification test were completed,with the speech sound(65 dB SPL)as the stimulus.The minimum audible angle(MAA)and root-mean-square error(RMSE)were obtained,and the RMSE of the affected side and the healthy side were calculated respectively.According to the WHO(2021)hearing loss classification criteria,the data were analyzed based on the pure-tone average(PTA)of the affected ear.And the best resident hearing at each frequency of the affected ear was recorded.RESULTS The performance of the unilateral sudden sensorineural hearing loss patients in the sound localization varied greatly.Some performed close to the normal level,while others completely lost the ability to localize sound.The RMSE of the moderate hearing loss group(≥35 dB HL)was significantly higher than that of the normal hearing group(P<0.01),the MAA of the moderate to severe hearing loss group(≥50 dB HL)showed statistically significant differencescompared with normal hearing group(P<0.001).The RMSE of the affected side of patients in the severe and above hearing loss group was significantly larger than that of the healthy side.Regression analysis showed that the best resident hearing at each frequency of the affected ear was the most significant factor affecting MAA(R2=0.572,P<0.001)and RMSE(R2=0.768,P<0.001).CONCLUSION The horizontal sound localization of unilateral sudden sensorineural hearing loss patients in the acute phase varies greatly.When the PTA of the affected side reaches moderate hearing loss,the localization ability is significantly lower than that of normal-hearing individuals.The best resident hearing at each frequency of the affected ear is the key factor affecting the localization ability.
3.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
4.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
5.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
6.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
7.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
8.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
9.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
10.The Development Convergence of Private Health Insurance in Basic Medical Insurance:International Practices and Implications
Jiayun WANG ; Linan WANG ; Bifan ZHU
Chinese Health Economics 2024;43(10):1-6
Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.
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