动态图模型提升电子病历多标签预测,兼顾精度与临床可解释性。
DynaGraph: Interpretable Multi-Label Prediction from EHRs via Dynamic Graph Learning and Contrastive Augmentation
- 基于对比增强的动态图学习,自动捕捉患者状态随时间演变关系。
- 在4个真实医疗数据集上,平衡准确率和敏感度显著优于现有方法。
- 通过伪注意力机制揭示关键临床变量,助力医生理解模型决策。
从纵向电子健康记录中学习受限于未能捕捉患者在临床环境中的时间轨迹。图模型可通过动态构建方式捕获多变量时间序列间的隐藏依赖关系。以往动态图模型需预设或静态图结构,而此类结构在多数情况下未知;且仅关注特征间的空间关联。此外,在医疗领域,模型可解释性是建立临床信任的关键要求。除注意力机制外,尚无针对多变量电子健康记录的可解释动态图框架。本文提出DynaGraph,一种端到端可解释的对比图模型,将多变量时间序列电子健康记录的动力学过程融入优化目标。我们在四个真实世界临床数据集上验证该模型,涵盖初级与二级医疗场景,人群多样性广,任务存在类别不平衡且为多标签问题。相比最先进的时间序列或动态图模型,DynaGraph在三个重症监护数据集和一个初级护理数据集中,显著提升了平衡准确率与灵敏度。通过伪注意力图构建方法,模型还揭示了不同临床协变量随时间的重要性,为临床验证提供支持。
原文摘要 · Abstract (English)
Learning from longitudinal electronic health records is limited if it does not capture the temporal trajectories of the patient's state in a clinical setting. Graph models allow us to capture the hidden dependencies of the multivariate time-series when the graphs are constructed in a similar dynamic manner. Previous dynamic graph models require a pre-defined and/or static graph structure, which is unknown in most cases, or they only capture the spatial relations between the features. Furthermore in healthcare, the interpretability of the model is an essential requirement to build trust with clinicians. In addition to previously proposed attention mechanisms, there has not been an interpretable dynamic graph framework for data from multivariate electronic health records (EHRs). Here, we propose DynaGraph, an end-to-end interpretable contrastive graph model that learns the dynamics of multivariate time-series EHRs as part of optimisation. We validate our model in four real-world clinical datasets, ranging from primary care to secondary care settings with broad demographics, in challenging settings where tasks are imbalanced and multi-labelled. Compared to state-of-the-art models, DynaGraph achieves significant improvements in balanced accuracy and sensitivity over the nearest complex competitors in time-series or dynamic graph modelling across three ICU and one primary care datasets. Through a pseudo-attention approach to graph construction, our model also indicates the importance of clinical covariates over time, providing means for clinical validation.
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