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Zheng P, Chen Y, Chen F, Zhou M, Xie C. Risk factors for the development of refeeding syndrome in adults: A systematic review. Nutr Clin Pract 2024. [PMID: 39187889 DOI: 10.1002/ncp.11203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 07/18/2024] [Accepted: 08/01/2024] [Indexed: 08/28/2024] Open
Abstract
Identifying patients with a particularly high risk of refeeding syndrome (RFS) is essential for taking preventive measures. To guide the development of clinical decision-making and risk prediction models or other screening tools for RFS, increased knowledge of risk factors is needed. Therefore, we conducted a systematic review to identify risk factors for the development of RFS. PubMed, EMBASE, Cochrane Library, and Web of Science were searched from January 1990 until March 2023. Studies investigating demographic, clinical, drug use, laboratory, and/or nutrition factors for RFS were considered. The Newcastle-Ottawa Scale was used to appraise the methodological quality of included studies. Of 1589 identified records, 30 studies were included. Thirty-three factors associated with increased risk of RFS after multivariable adjustments were identified. The following factors were reported by two or more studies, with 0-1 study reporting null findings: a previous history of alcohol misuse, cancer, comorbid hypertension, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, low Glasgow coma scale score, the use of diuretics before refeeding, low baseline serum prealbumin level, high baseline level of creatinine, and enteral nutrition. The majority of the studies (20, 66.7%) were of high methodological quality. In conclusion, this systematic review informs on several risk factors for RFS in patients. To improve risk stratification and guide development of risk prediction models or other screening tools, further confirmation is needed because there were a small number of studies and a low number of high-quality studies on each factor.
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Affiliation(s)
- Ping Zheng
- Department of Nursing, PengZhou People's Hospital, Chengdu, Sichuan, China
| | - Yilin Chen
- Department of Nursing, ChengFei Hospital, Chengdu, Sichuan, China
| | - Feng Chen
- Department of Oncology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Min Zhou
- Department of Urology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Caixia Xie
- Department of Nursing, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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2
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Atwal K. Artificial intelligence in clinical nutrition and dietetics: A brief overview of current evidence. Nutr Clin Pract 2024; 39:736-742. [PMID: 38591653 DOI: 10.1002/ncp.11150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
The rapid surge in artificial intelligence (AI) has dominated technological innovation in today's society. As experts begin to understand the potential, a spectrum of opportunities could yield a remarkable revolution. The upsurge in healthcare could transform clinical interventions and outcomes, but it risks dehumanization and increased unethical practices. The field of clinical nutrition and dietetics is no exception. This article finds a multitude of developments underway, which include the use of AI for malnutrition screening; predicting clinical outcomes, such as disease onset, and clinical risks, such as drug interactions; aiding interventions, such as estimating nutrient intake; applying precision nutrition, such as measuring postprandial glycemic response; and supporting workflow through chatbots trained on natural language models. Although the opportunity and scalability of AI is incalculably attractive, especially in the face of poor healthcare resources, the threat cannot be ignored. The risk of malpractice and lack of accountability are some of the main concerns. As such, the healthcare professional's responsibility remains paramount. The data used to train AI models could be biased, which could risk the quality of care to vulnerable or minority patient groups. Standardized AI-development protocols, benchmarked to care recommendations, with rigorous large-scale validation are required to maximize application among different settings. AI could overturn the healthcare landscape, and this article skims the surface of its potential in clinical nutrition and dietetics.
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Affiliation(s)
- Kiranjit Atwal
- Department of Nutritional Sciences, King's College London, London, UK
- School of Health Professions, University of Plymouth, Plymouth, UK
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3
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Kittrell HD, Shaikh A, Adintori PA, McCarthy P, Kohli-Seth R, Nadkarni GN, Sakhuja A. Role of artificial intelligence in critical care nutrition support and research. Nutr Clin Pract 2024. [PMID: 39073166 DOI: 10.1002/ncp.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/06/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Nutrition plays a key role in the comprehensive care of critically ill patients. Determining optimal nutrition strategy, however, remains a subject of intense debate. Artificial intelligence (AI) applications are becoming increasingly common in medicine, and specifically in critical care, driven by the data-rich environment of intensive care units. In this review, we will examine the evidence regarding the application of AI in critical care nutrition. As of now, the use of AI in critical care nutrition is relatively limited, with its primary emphasis on malnutrition screening and tolerance of enteral nutrition. Despite the current scarcity of evidence, the potential for AI for more personalized nutrition management for critically ill patients is substantial. This stems from the ability of AI to integrate multiple data streams reflecting patients' changing needs while addressing inherent heterogeneity. The application of AI in critical care nutrition holds promise for optimizing patient outcomes through tailored and adaptive nutrition interventions. A successful implementation of AI, however, necessitates a multidisciplinary approach, coupled with careful consideration of challenges related to data management, financial aspects, and patient privacy.
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Affiliation(s)
- Hannah D Kittrell
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed Shaikh
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter A Adintori
- Food and Nutrition Services Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Program in Rehabilitation Sciences, New York University Steinhardt, New York, New York, USA
| | - Paul McCarthy
- Department of Cardiovascular and Thoracic Surgery, Division of Cardiovascular Critical Care, West Virginia University, Morgantown, West Virginia, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ankit Sakhuja
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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Shin S, Choi TY, Han DH, Choi B, Cho E, Seog Y, Koo BN. An explainable machine learning model to predict early and late acute kidney injury after major hepatectomy. HPB (Oxford) 2024; 26:949-959. [PMID: 38705794 DOI: 10.1016/j.hpb.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/13/2023] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Risk assessment models for acute kidney injury (AKI) after major hepatectomy that differentiate between early and late AKI are lacking. This retrospective study aimed to create a model predicting AKI through machine learning and identify features that contribute to the development of early and late AKI. METHODS Patients that underwent major hepatectomy were categorized into the No-AKI, Early-AKI (within 48 h) or Late-AKI group (between 48 h and 7 days). Modeling was done with 20 perioperative features and the performance of prediction models were measured by the area under the receiver operating characteristic curve (AUROCC). Shapley Additive Explanation (SHAP) values were utilized to explain the outcome of the prediction model. RESULTS Of the 1383 patients included in this study, 1229, 110 and 44 patients were categorized into the No-AKI, Early-AKI and Late-AKI group, respectively. The CatBoost classifier exhibited the greatest AUROCC of 0.758 (95% CI: 0.671-0.847) and was found to differentiate well between Early and Late-AKI. We identified different perioperative features for predicting each outcome and found 1-year mortality to be greater for Early-AKI. CONCLUSIONS Our results suggest that risk factors are different for Early and Late-AKI after major hepatectomy, and 1-year mortality is greater for Early-AKI.
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Affiliation(s)
- Seokyung Shin
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea
| | - Tae Y Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea
| | - Dai H Han
- Department of Surgery, Division of Hepato-biliary and Pancreatic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea
| | - Boin Choi
- Severance Hospital, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea
| | - Eunsung Cho
- Severance Hospital, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea
| | - Yeong Seog
- Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodamun-gu, Seoul 03722, South Korea.
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Zhang Y, Xu J, Zhang C, Zhang X, Yuan X, Ni W, Zhang H, Zheng Y, Zhao Z. Community screening for dementia among older adults in China: a machine learning-based strategy. BMC Public Health 2024; 24:1206. [PMID: 38693495 PMCID: PMC11062005 DOI: 10.1186/s12889-024-18692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Dementia is a leading cause of disability in people older than 65 years worldwide. However, diagnosing dementia in its earliest symptomatic stages remains challenging. This study combined specific questions from the AD8 scale with comprehensive health-related characteristics, and used machine learning (ML) to construct diagnostic models of cognitive impairment (CI). METHODS The study was based on the Shenzhen Healthy Ageing Research (SHARE) project, and we recruited 823 participants aged 65 years and older, who completed a comprehensive health assessment and cognitive function assessments. Permutation importance was used to select features. Five ML models using BalanceCascade were applied to predict CI: a support vector machine (SVM), multilayer perceptron (MLP), AdaBoost, gradient boosting decision tree (GBDT), and logistic regression (LR). An AD8 score ≥ 2 was used to define CI as a baseline. SHapley Additive exPlanations (SHAP) values were used to interpret the results of ML models. RESULTS The first and sixth items of AD8, platelets, waist circumference, body mass index, carcinoembryonic antigens, age, serum uric acid, white blood cells, abnormal electrocardiogram, heart rate, and sex were selected as predictive features. Compared to the baseline (AUC = 0.65), the MLP showed the highest performance (AUC: 0.83 ± 0.04), followed by AdaBoost (AUC: 0.80 ± 0.04), SVM (AUC: 0.78 ± 0.04), GBDT (0.76 ± 0.04). Furthermore, the accuracy, sensitivity and specificity of four ML models were higher than the baseline. SHAP summary plots based on MLP showed the most influential feature on model decision for positive CI prediction was female sex, followed by older age and lower waist circumference. CONCLUSIONS The diagnostic models of CI applying ML, especially the MLP, were substantially more effective than the traditional AD8 scale with a score of ≥ 2 points. Our findings may provide new ideas for community dementia screening and to promote such screening while minimizing medical and health resources.
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Affiliation(s)
- Yan Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Jian Xu
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Chi Zhang
- Shenzhen Yiwei Technology Company, Shenzhen, Guangdong, 518000, China
| | - Xu Zhang
- National Engineering Laboratory of Big Data System Computing Technology, Shenzhen University, Shenzhen, Guangdong, 518060, China
| | - Xueli Yuan
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Wenqing Ni
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Hongmin Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Yijin Zheng
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Zhiguang Zhao
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China.
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Singer P, Robinson E, Raphaeli O. The future of artificial intelligence in clinical nutrition. Curr Opin Clin Nutr Metab Care 2024; 27:200-206. [PMID: 37650706 DOI: 10.1097/mco.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Artificial intelligence has reached the clinical nutrition field. To perform personalized medicine, numerous tools can be used. In this review, we describe how the physician can utilize the growing healthcare databases to develop deep learning and machine learning algorithms, thus helping to improve screening, assessment, prediction of clinical events and outcomes related to clinical nutrition. RECENT FINDINGS Artificial intelligence can be applied to all the fields of clinical nutrition. Improving screening tools, identifying malnourished cancer patients or obesity using large databases has been achieved. In intensive care, machine learning has been able to predict enteral feeding intolerance, diarrhea, or refeeding hypophosphatemia. The outcome of patients with cancer can also be improved. Microbiota and metabolomics profiles are better integrated with the clinical condition using machine learning. However, ethical considerations and limitations of the use of artificial intelligence should be considered. SUMMARY Artificial intelligence is here to support the decision-making process of health professionals. Knowing not only its limitations but also its power will allow precision medicine in clinical nutrition as well as in the rest of the medical practice.
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Affiliation(s)
- Pierre Singer
- Herzlia Medical Center, Intensive Care Unit, Herzlia
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Eyal Robinson
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Orit Raphaeli
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv
- Ariel University, Department of Industrial Engineering & Management, Ariel, Israel
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7
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Ben-Dov IZ, Potruch A, Abbasi M. Prophylactic Phosphate Restriction: A Strategy to Mitigate AKI-Associated Complications. J Am Soc Nephrol 2024; 35:255-256. [PMID: 38273785 PMCID: PMC10914209 DOI: 10.1681/asn.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Iddo Z. Ben-Dov
- Internal Medicine B, Laboratory of Medical Transcriptomics, Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | - Assaf Potruch
- Department of Nephrology and Hypertension, Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | - Momen Abbasi
- Department of Nephrology and Hypertension, Hadassah—Hebrew University Medical Center, Jerusalem, Israel
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Bond A, Mccay K, Lal S. Artificial intelligence & clinical nutrition: What the future might have in store. Clin Nutr ESPEN 2023; 57:542-549. [PMID: 37739704 DOI: 10.1016/j.clnesp.2023.07.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/02/2023] [Accepted: 07/17/2023] [Indexed: 09/24/2023]
Abstract
Artificial Intelligence (AI) is a rapidly emerging technology in healthcare that has the potential to revolutionise clinical nutrition. AI can assist in analysing complex data, interpreting medical images, and providing personalised nutrition interventions for patients. Clinical nutrition is a critical aspect of patient care, and AI can help clinicians make more informed decisions regarding patients' nutritional requirements, disease prevention, and management. AI algorithms can analyse large datasets to identify novel associations between diet and disease outcomes, enabling clinicians to make evidence-based nutritional recommendations. AI-powered devices and applications can also assist in tracking dietary intake, providing feedback, and motivating patients towards healthier food choices. However, the adoption of AI in clinical nutrition raises several ethical and regulatory concerns, such as data privacy and bias. Further research is needed to assess the clinical effectiveness and safety of AI-powered nutrition interventions. In conclusion, AI has the potential to transform clinical nutrition, but its integration into clinical practice should be carefully monitored to ensure patient safety and benefit. This article discusses the current and future applications of AI in clinical nutrition and highlights its potential benefits.
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Affiliation(s)
- Ashley Bond
- Intestinal Failure Unit, Salford Royal Foundation Trust, UK; University of Manchester, Manchester, UK.
| | - Kevin Mccay
- Manchester Metropolitan University, Manchester, UK; Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, UK; University of Manchester, Manchester, UK
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Raphaeli O, Statlender L, Hajaj C, Bendavid I, Goldstein A, Robinson E, Singer P. Using Machine-Learning to Assess the Prognostic Value of Early Enteral Feeding Intolerance in Critically Ill Patients: A Retrospective Study. Nutrients 2023; 15:2705. [PMID: 37375609 DOI: 10.3390/nu15122705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The association between gastrointestinal intolerance during early enteral nutrition (EN) and adverse clinical outcomes in critically ill patients is controversial. We aimed to assess the prognostic value of enteral feeding intolerance (EFI) markers during early ICU stays and to predict early EN failure using a machine learning (ML) approach. METHODS We performed a retrospective analysis of data from adult patients admitted to Beilinson Hospital ICU between January 2011 and December 2018 for more than 48 h and received EN. Clinical data, including demographics, severity scores, EFI markers, and medications, along with 72 h after admission, were analyzed by ML algorithms. Prediction performance was assessed by the area under the receiver operating characteristics (AUCROC) of a ten-fold cross-validation set. RESULTS The datasets comprised 1584 patients. The means of the cross-validation AUCROCs for 90-day mortality and early EN failure were 0.73 (95% CI 0.71-0.75) and 0.71 (95% CI 0.67-0.74), respectively. Gastric residual volume above 250 mL on the second day was an important component of both prediction models. CONCLUSIONS ML underlined the EFI markers that predict poor 90-day outcomes and early EN failure and supports early recognition of at-risk patients. Results have to be confirmed in further prospective and external validation studies.
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Affiliation(s)
- Orit Raphaeli
- Industrial Engineering and Management, Ariel University, Ariel 40700, Israel
- Institute for Nutrition Research, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel
| | - Liran Statlender
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Chen Hajaj
- Industrial Engineering and Management, Ariel University, Ariel 40700, Israel
- Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel
| | - Itai Bendavid
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Anat Goldstein
- Industrial Engineering and Management, Ariel University, Ariel 40700, Israel
- Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel
| | - Eyal Robinson
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Pierre Singer
- Institute for Nutrition Research, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
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10
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Wang YX, Li XL, Zhang LH, Li HN, Liu XM, Song W, Pang XF. Machine learning algorithms assist early evaluation of enteral nutrition in ICU patients. Front Nutr 2023; 10:1060398. [PMID: 37125050 PMCID: PMC10140307 DOI: 10.3389/fnut.2023.1060398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background This study applied machine learning (ML) algorithms to construct a model for predicting EN initiation for patients in the intensive care unit (ICU) and identifying populations in need of EN at an early stage. Methods This study collected patient information from the Medical Information Mart for Intensive Care IV database. All patients enrolled were split randomly into a training set and a validation set. Six ML models were established to evaluate the initiation of EN, and the best model was determined according to the area under curve (AUC) and accuracy. The best model was interpreted using the Local Interpretable Model-Agnostic Explanations (LIME) algorithm and SHapley Additive exPlanation (SHAP) values. Results A total of 53,150 patients participated in the study. They were divided into a training set (42,520, 80%) and a validation set (10,630, 20%). In the validation set, XGBoost had the optimal prediction performance with an AUC of 0.895. The SHAP values revealed that sepsis, sequential organ failure assessment score, and acute kidney injury were the three most important factors affecting EN initiation. The individualized forecasts were displayed using the LIME algorithm. Conclusion The XGBoost model was established and validated for early prediction of EN initiation in ICU patients.
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Affiliation(s)
- Ya-Xi Wang
- Department of Hospital-acquired Infection Control, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xun-Liang Li
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ling-Hui Zhang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Hai-Na Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiao-Min Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wen Song
- Department of Endoscopy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xu-Feng Pang
- Department of Hospital-acquired Infection Control, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- *Correspondence: Xu-Feng Pang,
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11
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Kirk D, Kok E, Tufano M, Tekinerdogan B, Feskens EJM, Camps G. Machine Learning in Nutrition Research. Adv Nutr 2022; 13:2573-2589. [PMID: 36166846 PMCID: PMC9776646 DOI: 10.1093/advances/nmac103] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/02/2022] [Accepted: 09/22/2022] [Indexed: 01/29/2023] Open
Abstract
Data currently generated in the field of nutrition are becoming increasingly complex and high-dimensional, bringing with them new methods of data analysis. The characteristics of machine learning (ML) make it suitable for such analysis and thus lend itself as an alternative tool to deal with data of this nature. ML has already been applied in important problem areas in nutrition, such as obesity, metabolic health, and malnutrition. Despite this, experts in nutrition are often without an understanding of ML, which limits its application and therefore potential to solve currently open questions. The current article aims to bridge this knowledge gap by supplying nutrition researchers with a resource to facilitate the use of ML in their research. ML is first explained and distinguished from existing solutions, with key examples of applications in the nutrition literature provided. Two case studies of domains in which ML is particularly applicable, precision nutrition and metabolomics, are then presented. Finally, a framework is outlined to guide interested researchers in integrating ML into their work. By acting as a resource to which researchers can refer, we hope to support the integration of ML in the field of nutrition to facilitate modern research.
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Affiliation(s)
- Daniel Kirk
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Esther Kok
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Michele Tufano
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Bedir Tekinerdogan
- Information Technology Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Guido Camps
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.,OnePlanet Research Center, Wageningen, The Netherlands
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12
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COVLIAS 2.0-cXAI: Cloud-Based Explainable Deep Learning System for COVID-19 Lesion Localization in Computed Tomography Scans. Diagnostics (Basel) 2022; 12:diagnostics12061482. [PMID: 35741292 PMCID: PMC9221733 DOI: 10.3390/diagnostics12061482] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The previous COVID-19 lung diagnosis system lacks both scientific validation and the role of explainable artificial intelligence (AI) for understanding lesion localization. This study presents a cloud-based explainable AI, the “COVLIAS 2.0-cXAI” system using four kinds of class activation maps (CAM) models. Methodology: Our cohort consisted of ~6000 CT slices from two sources (Croatia, 80 COVID-19 patients and Italy, 15 control patients). COVLIAS 2.0-cXAI design consisted of three stages: (i) automated lung segmentation using hybrid deep learning ResNet-UNet model by automatic adjustment of Hounsfield units, hyperparameter optimization, and parallel and distributed training, (ii) classification using three kinds of DenseNet (DN) models (DN-121, DN-169, DN-201), and (iii) validation using four kinds of CAM visualization techniques: gradient-weighted class activation mapping (Grad-CAM), Grad-CAM++, score-weighted CAM (Score-CAM), and FasterScore-CAM. The COVLIAS 2.0-cXAI was validated by three trained senior radiologists for its stability and reliability. The Friedman test was also performed on the scores of the three radiologists. Results: The ResNet-UNet segmentation model resulted in dice similarity of 0.96, Jaccard index of 0.93, a correlation coefficient of 0.99, with a figure-of-merit of 95.99%, while the classifier accuracies for the three DN nets (DN-121, DN-169, and DN-201) were 98%, 98%, and 99% with a loss of ~0.003, ~0.0025, and ~0.002 using 50 epochs, respectively. The mean AUC for all three DN models was 0.99 (p < 0.0001). The COVLIAS 2.0-cXAI showed 80% scans for mean alignment index (MAI) between heatmaps and gold standard, a score of four out of five, establishing the system for clinical settings. Conclusions: The COVLIAS 2.0-cXAI successfully showed a cloud-based explainable AI system for lesion localization in lung CT scans.
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Lew CCH, Ng PS, Wong KW, Puah SH, Lim CDQ, Kayambu G, Li AY, Toh CH, Venkatachalam J, Mukhopadhyay A. Nutrition support practices for critically ill patients with severe acute respiratory syndrome coronavirus-2: A multicentre observational study in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:329-340. [PMID: 35786753 DOI: 10.47102/annals-acadmedsg.202231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To improve the nutritional care and resource allocation of critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), we described their characteristics, treatment modalities and clinical outcomes, and compared their nutrition interventions against the American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations. METHODS This was a retrospective observational study conducted in 5 tertiary hospitals in Singapore. Characteristics, treatment modalities, clinical outcomes and nutrition interventions of critically ill patients with SARS-CoV-2 who received enteral and parenteral nutrition were collected between January and May 2020. RESULTS Among the 83 critically ill patients with SARS-CoV-2, 22 (28%) were obese, 45 (54%) had hypertension, and 21 (25%) had diabetes. Neuromuscular blockade, prone therapy and dialysis were applied in 70% (58), 47% (39) and 35% (29) of the patients, respectively. Refeeding hypophosphataemia and hospital mortality occurred respectively in 6% (5) and 18% (15) of the critically ill patients with SARS-CoV-2. Late enteral nutrition and cardiovascular comorbidities were associated with higher hospital mortality (adjusted relative risk 9.00, 95% confidence interval [CI] 2.25-35.99; 6.30, 95% CI 1.15-34.40, respectively). Prone therapy was not associated with a higher incidence of high gastric residual volume (≥250mL). The minimum caloric (15kcal/kg) and protein (1.2g/kg) recommendations of ASPEN were achieved in 54% (39) and 0% of the patients, respectively. CONCLUSION The high obesity prevalence and frequent usage of neuromuscular blockade, prone therapy, and dialysis had considerable implications for the nutritional care of critically ill patients with SARS-CoV-2. They also did not receive adequate calories and protein. More audits should be conducted to refine nutritional interventions and guidelines for this ever-evolving disease.
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Schönenberger KA, Dürig C, Huwiler VV, Reber E, Stanga Z. [Refeeding Syndrome: Where Do We Stand in 2022?]. PRAXIS 2022; 111:381-387. [PMID: 35611483 DOI: 10.1024/1661-8157/a003863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Refeeding Syndrome: Where Do We Stand in 2022? Abstract. The refeeding syndrome is a potentially life-threatening condition that can occur when refeeding malnourished patients. In recent years, two consensus manuscripts were published by the major clinical nutrition societies ESPEN and ASPEN. Pathophysiological aspects, clinical manifestations, prevention measures and criteria for diagnosis and management have been described in detail. The aim of this mini-review is to provide an evidence-based overview on the refeeding syndrome. For this purpose, the systematic literature search by Friedli et al. 2015 was updated. Evidence that the refeeding syndrome is associated with a negative clinical outcome exists. Many questions about management aspects remain unanswered. A robust randomized controlled trial is urgently needed to answer all these questions in an evidence-based manner and to elicit reliable evidence about independent predictors and an estimate of metabolic risk.
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Affiliation(s)
- Katja A Schönenberger
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
- Klinische Pharmazie und Epidemiologie, Departement Pharmazeutische Wissenschaften, Universität Basel, Basel, Schweiz
| | - Christa Dürig
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Valentina V Huwiler
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
- Klinische Pharmazie und Epidemiologie, Departement Pharmazeutische Wissenschaften, Universität Basel, Basel, Schweiz
| | - Emilie Reber
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Zeno Stanga
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
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