用Transformer模型分析医院数据,预测耐药菌感染风险并解释关键因素。
Explainable AI for Infection Prevention and Control: Modeling CPE Acquisition and Patient Outcomes in an Irish Hospital with Transformers
- 基于Transformer构建可解释的医疗预测模型
- 在耐药菌感染预测中表现优于传统模型,AUROC与敏感性更优
- 发现住院史、病房位置和接触网络结构是主要风险因素
碳青霉烯类耐药肠杆菌科细菌(CPE)是医院感染防控的重大挑战。本研究针对以往未充分探索的再入院、死亡率和住院时长等关联风险,提出一种可解释人工智能(XAI)建模框架,利用爱尔兰一家急性医院的电子病历数据,整合诊断编码、病房转移、患者人口学信息、感染相关变量及接触网络特征。对比多种Transformer架构与传统机器学习模型,结果显示TabTransformer在多个临床预测任务中表现最优,尤其在预测CPE感染方面具有更高的AUROC和敏感性。分析表明,既往医院暴露、入院背景及网络中心性等感染相关特征对结果预测影响显著。可解释性分析揭示‘居住地’‘入院病房’及既往住院史为关键风险因子,‘病房PageRank’等网络变量亦排名靠前,体现结构性暴露信息的价值。该研究展示了一套鲁棒且可解释的AI框架,可用于复杂电子病历数据中识别风险因素并预测CPE相关结局。
原文摘要 · Abstract (English)
Carbapenemase-Producing Enterobacteriace poses a critical concern for infection prevention and control in hospitals. However, predictive modeling of previously highlighted CPE-associated risks such as readmission, mortality, and extended length of stay (LOS) remains underexplored, particularly with modern deep learning approaches. This study introduces an eXplainable AI modeling framework to investigate CPE impact on patient outcomes from Electronic Medical Records data of an Irish hospital. We analyzed an inpatient dataset from an Irish acute hospital, incorporating diagnostic codes, ward transitions, patient demographics, infection-related variables and contact network features. Several Transformer-based architectures were benchmarked alongside traditional machine learning models. Clinical outcomes were predicted, and XAI techniques were applied to interpret model decisions. Our framework successfully demonstrated the utility of Transformer-based models, with TabTransformer consistently outperforming baselines across multiple clinical prediction tasks, especially for CPE acquisition (AUROC and sensitivity). We found infection-related features, including historical hospital exposure, admission context, and network centrality measures, to be highly influential in predicting patient outcomes and CPE acquisition risk. Explainability analyses revealed that features like "Area of Residence", "Admission Ward" and prior admissions are key risk factors. Network variables like "Ward PageRank" also ranked highly, reflecting the potential value of structural exposure information. This study presents a robust and explainable AI framework for analyzing complex EMR data to identify key risk factors and predict CPE-related outcomes. Our findings underscore the superior performance of the Transformer models and highlight the importance of diverse clinical and network features.
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