背景:COVID-19导致的住院时间(LOHS)造成了经济负担,医疗服务系统的成本以及患者和卫生工作者的高心理负担。这项研究的目的是采用基于线性回归模型的贝叶斯模型平均(BMA),并确定COVID-19LOHS的预测因子。
方法:在这项历史队列研究中,从5100名在医院数据库注册的COVID-19患者中,4996名患者有资格进入研究。数据包括人口统计,临床,生物标志物,和LOHS。影响LOHS的因素在六个模型中进行了拟合,包括逐步方法,AIC,经典线性回归模型中的BIC,使用奥卡姆窗口和马尔可夫链蒙特卡罗(MCMC)方法的两个BMA,和GBDT算法,一种新的机器学习方法。
结果:平均住院时间为6.7±5.7天。在拟合经典线性模型时,逐步法和AIC法(R2=0.168,调整后的R2=0.165)均优于BIC法(R2=0.160,调整后的R2=0.158)。在适应BMA时,Occam的Window模型的性能优于MCMC,R2=0.174。值R2=0.64的GBDT方法在测试数据集中的表现比BMA差,但在训练数据集中没有表现。基于六个拟合模型,在ICU住院,呼吸窘迫,年龄,糖尿病,CRP,PO2,WBC,AST,BUN,NLR与预测COVID-19的LOHS显著相关。
结论:使用Occam\'sWindow方法的BMA在预测测试数据集中的LOHS影响因素方面比其他模型具有更好的拟合和性能。
The length of hospital stay (LOHS) caused by COVID-19 has imposed a financial burden, and cost on the healthcare service system and a high psychological burden on patients and health workers. The purpose of this study is to adopt the Bayesian model averaging (BMA) based on linear regression models and to determine the predictors of the LOHS of COVID-19.
In this historical cohort study, from 5100 COVID-19 patients who had registered in the hospital database, 4996 patients were eligible to enter the study. The data included demographic, clinical, biomarkers, and LOHS. Factors affecting the LOHS were fitted in six models, including the stepwise method, AIC,
BIC in classical linear regression models, two BMA using Occam\'s Window and Markov Chain Monte Carlo (MCMC) methods, and GBDT algorithm, a new method of machine learning.
The average length of hospitalization was 6.7 ± 5.7 days. In fitting classical linear models, both stepwise and AIC methods (R 2 = 0.168 and adjusted R 2 = 0.165) performed better than
BIC (R 2 = 0.160 and adjusted = 0.158). In fitting the BMA, Occam\'s Window model has performed better than MCMC with R 2 = 0.174. The GBDT method with the value of R 2 = 0.64, has performed worse than the BMA in the testing dataset but not in the training dataset. Based on the six fitted models, hospitalized in ICU, respiratory distress, age, diabetes, CRP, PO2, WBC, AST, BUN, and NLR were associated significantly with predicting LOHS of COVID-19.
The BMA with Occam\'s Window method has a better fit and better performance in predicting affecting factors on the LOHS in the testing dataset than other models.