提出一种可生成通用病历嵌入的跨模态自回归模型,提升临床预测效果。
CAAT-EHR: Cross-Attentional Autoregressive Transformer for Multimodal Electronic Health Record Embeddings
- 用跨注意力融合多模态病历数据,自回归训练增强时序一致性
- 在死亡率、住院时长和阿尔茨海默病预测上,12项任务中11项超越原始数据模型
- 适合需要通用病历表示的临床预测研究,尤其关注多模态数据整合
电子健康记录(EHR)包含结构化(如检验、生命体征、影像)和非结构化(如临床笔记)的纵向患者信息。尽管深度学习模型如RNN和Transformer已推动单模态与多模态EHR分析,但现有方法通常针对特定下游任务优化,忽视可复用的通用患者表示。为此,我们提出CAAT-EHR——一种跨注意力自回归变换器架构,用于生成任务无关的多模态EHR长期嵌入。在该模型中,自注意力层捕捉各模态内的时序依赖,跨注意力层融合不同模态信息以建模复杂关联。预训练阶段,自回归解码器从融合嵌入中预测未来时间步,强化时序一致性并丰富编码器输出。训练完成后,仅使用编码器即可生成适用于多种预测任务的多功能多模态嵌入。CAAT-EHR在基准EHR数据集上显著提升死亡率预测、ICU住院时长估计和阿尔茨海默病诊断预测性能。使用其生成的嵌入的模型,在12项比较中,11项的F1分数和AUC均优于基于原始数据训练的模型。消融实验验证了跨模态融合与自回归精炼的关键作用。总体而言,CAAT-EHR提供了一个统一框架,用于学习通用且时序一致的多模态EHR表示,支持更可靠的临床决策支持系统。
原文摘要 · Abstract (English)
Electronic Health Records (EHRs) contain rich, longitudinal patient information across structured (e.g., labs, vitals, and imaging) and unstructured (e.g., clinical notes) modalities. While deep learning models such as RNNs and Transformers have advanced single- and multimodal EHR analysis, existing methods often optimize for specific downstream tasks and overlook the creation of generalizable patient representations that can be reused across multiple tasks. To address this gap, we propose CAAT-EHR, a novel Cross-Attentional Autoregressive Transformer architecture that produces task-agnostic, longitudinal embeddings of multimodal EHR data. In CAAT-EHR, self-attention layers capture temporal dependencies within each modality, while cross-attention layers fuse information across modalities to model complex interrelationships. During pre-training, an autoregressive decoder predicts future time steps from the fused embeddings, enforcing temporal consistency and enriching the encoder output. Once trained, the encoder alone generates versatile multimodal EHR embeddings that can be applied directly to a variety of predictive tasks. CAAT-EHR demonstrates significant improvements on benchmark EHR datasets for mortality prediction, ICU length-of-stay estimation, and Alzheimer's disease diagnosis prediction. Models using EHR embeddings generated by CAAT-EHR outperform models trained on raw EHR data in eleven out of twelve comparisons for F1 score and AUC across all three downstream tasks. Ablation studies confirm the critical roles of cross-modality fusion and autoregressive refinement. Overall, CAAT-EHR provides a unified framework for learning generalizable, temporally consistent multimodal EHR representations that support more reliable clinical decision support systems.
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