提出可解释的重症监护死亡预测模型,让AI像医生一样思考。
Think as a Doctor: An Interpretable AI Approach for ICU Mortality Prediction
- 用原型学习识别临床病程,结合风险调节实现预后意识。
- 在多个数据集上准确率超越现有模型,且临床解释更可信。
- 适合医疗AI研发与临床决策支持系统设计者使用。
重症监护室(ICU)死亡率预测旨在利用患者入院早期的电子健康记录(EHRs)预估其出院时的死亡状态,对危重症护理至关重要。仅追求预测准确性不足,需兼顾可解释性以建立临床信任并满足监管要求。理想方案应内嵌可解释性,并与三大临床决策要素一致:临床病程识别、人口统计异质性和预后意识。然而,传统方法多关注人口统计异质性,忽略临床病程识别与预后意识;近年原型学习虽改善病程识别,但未整合其他要素。为此,本文提出ProtoDoctor框架,通过两个创新模块实现三者融合:预后性临床病程识别模块利用原型学习识别病程,并通过新型正则化机制实现预后意识;人口统计异质性识别模块通过分组原型与风险调整建模异质性。实证评估显示,ProtoDoctor在多个基准上优于先进模型;人工评估证实其解释更具临床意义、可信且适用于临床实践。
原文摘要 · Abstract (English)
Intensive Care Unit (ICU) mortality prediction, which estimates a patient's mortality status at discharge using EHRs collected early in an ICU admission, is vital in critical care. For this task, predictive accuracy alone is insufficient; interpretability is equally essential for building clinical trust and meeting regulatory standards, a topic that has attracted significant attention in information system research. Accordingly, an ideal solution should enable intrinsic interpretability and align its reasoning with three key elements of the ICU decision-making practices: clinical course identification, demographic heterogeneity, and prognostication awareness. However, conventional approaches largely focus on demographic heterogeneity, overlooking clinical course identification and prognostication awareness. Recent prototype learning methods address clinical course identification, yet the integration of the other elements into such frameworks remains underexplored. To address these gaps, we propose ProtoDoctor, a novel ICU mortality prediction framework that delivers intrinsic interpretability while integrating all three elements of the ICU decision-making practices into its reasoning process. Methodologically, ProtoDoctor features two key innovations: the Prognostic Clinical Course Identification module and the Demographic Heterogeneity Recognition module. The former enables the identification of clinical courses via prototype learning and achieves prognostication awareness using a novel regularization mechanism. The latter models demographic heterogeneity through cohort-specific prototypes and risk adjustments. Extensive empirical evaluations demonstrate that ProtoDoctor outperforms state-of-the-art baselines in predictive accuracy. Human evaluations further confirm that its interpretations are more clinically meaningful, trustworthy, and applicable in ICU practice.
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