Abstract：
OBJECTIVE: We aim to establish deep learning models to optimize the individualized energy delivery for septic patients.
METHODS: We conducted a study of adult septic patients in ICU, collecting 47 indicators for 14 days. We filtered out nutrition-related features and divided the data into datasets according to the three metabolic phases proposed by ESPEN: acute early, acute late, and rehabilitation. We then established optimal energy target models for each phase using deep learning and conducted external validation.
RESULTS: A total of 179 patients in training dataset and 98 patients in external validation dataset were included in this study, and total data size was 3115 elements. The age, weight and BMI of the patients were 63.05 (95%CI 60.42-65.68), 61.31(95%CI 59.62-63.00) and 22.70 (95%CI 22.21-23.19), respectively. And 26.0% (72) of the patients were female. The models indicated that the optimal energy targets in the three phases were 900kcal/d, 2300kcal/d, and 2000kcal/d, respectively. Excessive energy intake increased mortality rapidly in the early period of the acute phase. Insufficient energy in the late period of the acute phase significantly raised the mortality as well. For the rehabilitation phase, too much or too little energy delivery were both associated with elevated death risk.
CONCLUSIONS: Our study established time-series prediction models for septic patients to optimize energy delivery in the ICU. We recommended permissive underfeeding only in the early acute phase. Later, increased energy intake may improve survival and settle energy debts caused by underfeeding.
METHODS: We conducted a study of adult septic patients in ICU, collecting 47 indicators for 14 days. We filtered out nutrition-related features and divided the data into datasets according to the three metabolic phases proposed by ESPEN: acute early, acute late, and rehabilitation. We then established optimal energy target models for each phase using deep learning and conducted external validation.
RESULTS: A total of 179 patients in training dataset and 98 patients in external validation dataset were included in this study, and total data size was 3115 elements. The age, weight and BMI of the patients were 63.05 (95%CI 60.42-65.68), 61.31(95%CI 59.62-63.00) and 22.70 (95%CI 22.21-23.19), respectively. And 26.0% (72) of the patients were female. The models indicated that the optimal energy targets in the three phases were 900kcal/d, 2300kcal/d, and 2000kcal/d, respectively. Excessive energy intake increased mortality rapidly in the early period of the acute phase. Insufficient energy in the late period of the acute phase significantly raised the mortality as well. For the rehabilitation phase, too much or too little energy delivery were both associated with elevated death risk.
CONCLUSIONS: Our study established time-series prediction models for septic patients to optimize energy delivery in the ICU. We recommended permissive underfeeding only in the early acute phase. Later, increased energy intake may improve survival and settle energy debts caused by underfeeding.
摘要：
目的：我们旨在建立深度学习模型，以优化脓毒症患者的个性化能量传递。
方法：我们对ICU的成人脓毒症患者进行了一项研究，14天收集47项指标。我们筛选出与营养相关的特征，并根据ESPEN提出的三个代谢阶段将数据分为数据集：急性早期，急性晚期，和康复。然后，我们使用深度学习为每个阶段建立了最佳能量目标模型，并进行了外部验证。
结果：本研究共纳入了训练数据集中的179名患者和外部验证数据集中的98名患者。总数据大小为3115个元素。年龄,患者的体重和BMI为63.05（95CI60.42-65.68），61.31（95CI59.62-63.00）和22.70（95CI22.21-23.19），分别。26.0％（72）的患者为女性。模型表明，三个阶段的最佳能量目标为900kcal/d，2300kcal/d,和2000kcal/d，分别。在急性期的早期，过多的能量摄入迅速增加了死亡率。急性期后期能量不足也显着增加了死亡率。对于康复阶段，能量传递过多或过少均与死亡风险升高相关.
结论：我们的研究建立了脓毒症患者的时间序列预测模型，以优化ICU中的能量输送。我们建议仅在急性期早期允许喂养不足。稍后，增加能量摄入可以改善生存和解决能源债务造成的不足。
方法：我们对ICU的成人脓毒症患者进行了一项研究，14天收集47项指标。我们筛选出与营养相关的特征，并根据ESPEN提出的三个代谢阶段将数据分为数据集：急性早期，急性晚期，和康复。然后，我们使用深度学习为每个阶段建立了最佳能量目标模型，并进行了外部验证。
结果：本研究共纳入了训练数据集中的179名患者和外部验证数据集中的98名患者。总数据大小为3115个元素。年龄,患者的体重和BMI为63.05（95CI60.42-65.68），61.31（95CI59.62-63.00）和22.70（95CI22.21-23.19），分别。26.0％（72）的患者为女性。模型表明，三个阶段的最佳能量目标为900kcal/d，2300kcal/d,和2000kcal/d，分别。在急性期的早期，过多的能量摄入迅速增加了死亡率。急性期后期能量不足也显着增加了死亡率。对于康复阶段，能量传递过多或过少均与死亡风险升高相关.
结论：我们的研究建立了脓毒症患者的时间序列预测模型，以优化ICU中的能量输送。我们建议仅在急性期早期允许喂养不足。稍后，增加能量摄入可以改善生存和解决能源债务造成的不足。
