arXiv:2502.06124cs.LGcs.AI2025-02被引 26

用AI动态预测患者风险,比传统系统更准更个性化。

Foundation Model of Electronic Medical Records for Adaptive Risk Estimation

  • 基于电子病历构建患者健康时间序列,用Transformer动态建模风险
  • 在MIMIC-IV数据上预测住院、转ICU等事件,AUC表现优于现有模型
  • 提供个体化解释模块,帮助医生理解风险来源,适合临床决策支持

医院难以准确预测关键临床结局。传统早期预警系统如NEWS和MEWS依赖静态变量和固定阈值,限制了适应性、准确性和个性化。我们此前开发了增强型健康结果模拟变压器(ETHOS),该模型将电子病历中的患者健康时间序列(PHTs)进行分词,并利用Transformer架构预测未来PHTs。ETHOS是可扩展的通用框架。本文提出自适应风险评估系统(ARES),基于ETHOS计算临床定义的关键事件的动态、个性化风险概率,并包含个性化可解释模块,突出影响风险的关键临床因素。我们在MIMIC-IV v2.2数据集及其急诊科扩展数据集上评估ARES,对比经典预警系统与现代机器学习模型。整个数据集被分词生成285,622个PHTs,超过3.6亿个标记。ETHOS在预测住院、转入ICU及长期住院方面表现优异,各项指标AUC均领先。风险估计在不同人口学亚组中稳健,校准曲线验证了模型可靠性。可解释模块揭示了患者特异性风险因素。ARES依托ETHOS,推动预测性医疗人工智能发展,实现动态、实时、个性化的风险评估与患者级可解释性。尽管结果有前景,其临床影响仍待验证。未来工作将聚焦于真实场景下的实用价值。代码已开源以促进后续研究。

原文摘要 · Abstract (English)

Hospitals struggle to predict critical outcomes. Traditional early warning systems, like NEWS and MEWS, rely on static variables and fixed thresholds, limiting their adaptability, accuracy, and personalization. We previously developed the Enhanced Transformer for Health Outcome Simulation (ETHOS), an AI model that tokenizes patient health timelines (PHTs) from EHRs and uses transformer-based architectures to predict future PHTs. ETHOS is a versatile framework for developing a wide range of applications. In this work, we develop the Adaptive Risk Estimation System (ARES) that leverages ETHOS to compute dynamic, personalized risk probabilities for clinician-defined critical events. ARES also features a personalized explainability module that highlights key clinical factors influencing risk estimates. We evaluated ARES using the MIMIC-IV v2.2 dataset together with its Emergency Department (ED) extension and benchmarked performance against both classical early warning systems and contemporary machine learning models. The entire dataset was tokenized resulting in 285,622 PHTs, comprising over 360 million tokens. ETHOS outperformed benchmark models in predicting hospital admissions, ICU admissions, and prolonged stays, achieving superior AUC scores. Its risk estimates were robust across demographic subgroups, with calibration curves confirming model reliability. The explainability module provided valuable insights into patient-specific risk factors. ARES, powered by ETHOS, advances predictive healthcare AI by delivering dynamic, real-time, personalized risk estimation with patient-specific explainability. Although our results are promising, the clinical impact remains uncertain. Demonstrating ARES's true utility in real-world settings will be the focus of our future work. We release the source code to facilitate future research.

医疗AI风险预测可解释性Transformer

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