将临床计算器融入动态图模型,提升脓毒症早期预测的透明度与准确性。
SepsisCalc: Integrating Clinical Calculators into Early Sepsis Prediction via Dynamic Temporal Graph Construction
- 构建动态时间图表示电子病历,实时补全缺失变量并集成临床计算器
- 在真实数据集上优于现有模型,关键指标提升显著
- 生成可解释的器官功能障碍预警,助力临床决策
脓毒症是由感染引发的免疫系统失调导致的器官功能障碍。早期预测和识别有助于及时干预,改善临床结局。临床计算器(如SOFA的六器官功能障碍评估)在临床工作流中对脓毒症判断至关重要,提供基于证据的风险评估。然而,现有人工智能脓毒症预测模型通常仅输出单一风险评分,未融合临床计算器对器官功能障碍的评估,导致模型对临床医生而言缺乏说服力和透明性。为此,我们提出SepsisCalc框架,模仿临床医生的工作流程,将临床计算器融入预测模型,实现兼具临床可解释性与高精度的模型部署。实际中,临床计算器依赖多个电子病历(EHR)中的组件变量,若变量缺失则难以应用。为此,我们通过将EHR表示为时间图,并引入学习模块动态补充准确估计的计算器结果。在真实世界数据集上的实验表明,所提模型在脓毒症预测任务上超越当前最优方法。此外,我们开发了系统以识别器官功能障碍和潜在脓毒症风险,提供人机交互工具,帮助临床医生理解预测结果,并针对特定功能障碍制定及时干预措施,为早期干预的可行动临床决策支持铺平道路。
原文摘要 · Abstract (English)
Sepsis is an organ dysfunction caused by a deregulated immune response to an infection. Early sepsis prediction and identification allow for timely intervention, leading to improved clinical outcomes. Clinical calculators (e.g., the six-organ dysfunction assessment of SOFA) play a vital role in sepsis identification within clinicians' workflow, providing evidence-based risk assessments essential for sepsis diagnosis. However, artificial intelligence (AI) sepsis prediction models typically generate a single sepsis risk score without incorporating clinical calculators for assessing organ dysfunctions, making the models less convincing and transparent to clinicians. To bridge the gap, we propose to mimic clinicians' workflow with a novel framework SepsisCalc to integrate clinical calculators into the predictive model, yielding a clinically transparent and precise model for utilization in clinical settings. Practically, clinical calculators usually combine information from multiple component variables in Electronic Health Records (EHR), and might not be applicable when the variables are (partially) missing. We mitigate this issue by representing EHRs as temporal graphs and integrating a learning module to dynamically add the accurately estimated calculator to the graphs. Experimental results on real-world datasets show that the proposed model outperforms state-of-the-art methods on sepsis prediction tasks. Moreover, we developed a system to identify organ dysfunctions and potential sepsis risks, providing a human-AI interaction tool for deployment, which can help clinicians understand the prediction outputs and prepare timely interventions for the corresponding dysfunctions, paving the way for actionable clinical decision-making support for early intervention.
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