用大模型区分生命体征与化验指标,提升不规则医疗数据建模能力
Mind the Missing: Variable-Aware Representation Learning for Irregular EHR Time Series using Large Language Models
- 按变量类型分别处理:生命体征转为语言空间,化验指标用摘要值或占位符
- 在PhysioNet上性能超越现有方法,高缺失率下仍保持稳定表现
- 适合处理真实临床场景中变量缺失严重的电子病历时间序列
电子病历中的时间序列普遍存在采样不规则和高缺失问题,临床变量的测量时间取决于工作流程与干预时机。为此,我们提出VITAL框架,一种基于大语言模型的、面向不规则生理时间序列的变量感知表示学习方法。VITAL将临床变量分为两类:频繁采集且具时序模式的生命体征,以及零星测量且无时序结构的化验指标。前者被重编码至语言空间,使大模型能捕捉时序上下文并显式推理缺失值;后者则根据可得性,采用代表性摘要值或可学习的[未测量]占位符进行嵌入。在PhysioNet基准数据集上的大量实验表明,VITAL优于专为不规则时间序列设计的现有先进方法,并在高缺失率下保持鲁棒性能,适用于真实临床中关键变量常不可用的场景。
原文摘要 · Abstract (English)
Irregular sampling and high missingness are intrinsic challenges in modeling time series derived from electronic health records (EHRs),where clinical variables are measured at uneven intervals depending on workflow and intervention timing. To address this, we propose VITAL, a variable-aware, large language model (LLM) based framework tailored for learning from irregularly sampled physiological time series. VITAL differentiates between two distinct types of clinical variables: vital signs, which are frequently recorded and exhibit temporal patterns, and laboratory tests, which are measured sporadically and lack temporal structure. It reprograms vital signs into the language space, enabling the LLM to capture temporal context and reason over missing values through explicit encoding. In contrast, laboratory variables are embedded either using representative summary values or a learnable [Not measured] token, depending on their availability. Extensive evaluations on the benchmark datasets from the PhysioNet demonstrate that VITAL outperforms state of the art methods designed for irregular time series. Furthermore, it maintains robust performance under high levels of missingness, which is prevalent in real world clinical scenarios where key variables are often unavailable.
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