Uplift modeling to predict individual treatment effects of renal replacement therapy in sepsis-associated acute kidney injury patients.

Renal replacement therapy (RRT) is a crucial treatment for sepsis-associated acute kidney injury (S-AKI), but it is uncertain which S-AKI patients should receive immediate RRT. Identifying the characteristics of patients who may benefit the most from RRT is an important task. This retrospective study utilized a public database and enrolled S-AKI patients, who were divided into RRT and non-RRT groups. Uplift modeling was used to estimate the individual treatment effect (ITE) of RRT. The validity of different models was compared using a qini curve. After labeling the patients in the validation cohort, we characterized the patients who would benefit the most from RRT and created a nomogram. A total of 8289 patients were assessed, among whom 591 received RRT, and 7698 did not receive RRT. The RRT group had a higher severity of illness than the non-RRT group, with a Sequential Organ Failure Assessment (SOFA) score of 9 (IQR 6,11) vs. 5 (IQR 3,7). The 28-day mortality rate was higher in the RRT group than the non-RRT group (34.83% vs. 14.61%, p < 0.0001). Propensity score matching (PSM) was used to balance baseline characteristics, 458 RRT patients and an equal number of non-RRT patients were enrolled for further research. After PSM, 28-day mortality of RRT and non-RRT groups were 32.3% vs. 39.3%, P = 0.033. Using uplift modeling, we found that urine output, fluid input, mean blood pressure, body temperature, and lactate were the top 5 factors that had the most influence on RRT effect. The area under the uplift curve (AUUC) of the class transformation model was 0.068, the AUUC of SOFA was 0.018, and the AUUC of Kdigo-stage was 0.050. The class transformation model was more efficient in predicting individual treatment effect. A logistic regression model was developed, and a nomogram was drawn to predict whether an S-AKI patient can benefit from RRT. Six factors were taken into account (urine output, creatinine, lactate, white blood cell count, glucose, respiratory rate). Uplift modeling can better predict the ITE of RRT on S-AKI patients than conventional score systems such as Kdigo and SOFA. We also found that white blood cell count is related to the benefits of RRT, suggesting that changes in inflammation levels may be associated with the effects of RRT on S-AKI patients.

Factors Affecting Intention to Leave Among ICU Healthcare Professionals in China: Insights from a Cross-Sectional Survey and XGBoost Analysis.

Background: The intention to leave among intensive care unit (ICU) healthcare professionals in China has become a concerning issue. Therefore, understanding the factors influencing the intention to leave and implementing appropriate measures have become urgent needs for maintaining a stable healthcare workforce. Objective: This study aims to investigate the current status of intention to leave among ICU healthcare professionals in China, explore the relevant factors affecting this intention, and provide targeted recommendations to reduce the intention to leave among healthcare professionals. Methods: A cross-sectional survey was conducted, involving ICU healthcare professionals from 3-A hospitals of the 34 provinces in China. The survey encompassed 22 indicators, including demographic information (marital status, children, income), work-related factors (weekly working hours, night shift frequency, hospital environment), and psychological assessment (using Symptom Checklist-90 (SCL-90)). The data from a sample population of 3653 individuals were analyzed using the extreme gradient boosting (XGBoost) method to predict intention to leave. Results: The survey results revealed that 62.09% (2268 individuals) of the surveyed ICU healthcare professionals expressed an intention to leave. The XGBoost model achieved a predictive accuracy of 75.38% and an Area Under the Curve (AUC) of 0.77. Conclusion: Satisfaction with income was found to be the strongest predictor of intention to leave among ICU healthcare professionals. Additionally, factors such as years of experience, night shift frequency, and pride in hospital work were found to play significant roles in influencing the intention to leave.