用不确定性感知方法提前两年预测帕金森药量调整,让用药更安全精准。
Uncertainty-Aware Prediction of Parkinson's Disease Medication Needs: A Two-Stage Conformal Prediction Approach
- 两阶段共形预测框架,结合电子病历识别需调药患者并预估剂量变化
- 在631例住院数据上实现准确覆盖率,区间长度优于传统方法
- 适合临床医生做用药决策支持,尤其关注用药安全与长期管理
帕金森病药物管理因疾病进展和治疗反应差异大而具挑战性。神经科医生需在控制症状与避免副作用间权衡,当前依赖试错法,缺乏系统预测工具。尽管机器学习有进展,但因仅输出点估计且忽略不确定性,难以被临床采纳。本文提出一种两阶段共形预测方法,基于佛罗里达大学健康中心2011-2021年631例住院患者电子病历数据,预测未来两年内药物调整需求,特别处理了药物方案稳定(零膨胀)的数据特征。该方法可生成具有统计保证的预测区间,在保持边缘覆盖率的同时缩短区间长度,短期预测更精确,长期则留出更大余地。通过量化不确定性,助力医生制定更安全、个性化的左旋多巴等效日剂量调整方案,优化症状控制,减少副作用,提升生活质量。
原文摘要 · Abstract (English)
Parkinson's Disease (PD) medication management presents unique challenges due to heterogeneous disease progression and treatment response. Neurologists must balance symptom control with optimal dopaminergic dosing based on functional disability while minimizing side effects. This balance is crucial as inadequate or abrupt changes can cause levodopa-induced dyskinesia, wearing off, and neuropsychiatric effects, significantly reducing quality of life. Current approaches rely on trial-and-error decisions without systematic predictive methods. Despite machine learning advances, clinical adoption remains limited due to reliance on point predictions that do not account for prediction uncertainty, undermining clinical trust and utility. Clinicians require not only predictions of future medication needs but also reliable confidence measures. Without quantified uncertainty, adjustments risk premature escalation to maximum doses or prolonged inadequate symptom control. We developed a conformal prediction framework anticipating medication needs up to two years in advance with reliable prediction intervals and statistical guarantees. Our approach addresses zero-inflation in PD inpatient data, where patients maintain stable medication regimens between visits. Using electronic health records from 631 inpatient admissions at University of Florida Health (2011-2021), our two-stage approach identifies patients likely to need medication changes, then predicts required levodopa equivalent daily dose adjustments. Our framework achieved marginal coverage while reducing prediction interval lengths compared to traditional approaches, providing precise predictions for short-term planning and wider ranges for long-term forecasting. By quantifying uncertainty, our approach enables evidence-based decisions about levodopa dosing, optimizing symptom control while minimizing side effects and improving life quality.
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