用医学知识增强图神经网络,提升电子病历中的疾病风险预测准确率
KAT-GNN: A Knowledge-Augmented Temporal Graph Neural Network for Risk Prediction in Electronic Health Records
- 构建患者多模态图,融合医学本体与病历共现信息增强关系
- 在冠心病和院内死亡预测上分别达0.9269和0.8849的AUROC
- 适合医疗AI研究者及临床决策支持系统开发者参考
基于电子健康记录(EHR)的临床风险预测对及时干预和辅助决策至关重要。然而,异构且不规则的时序EHR数据建模面临挑战。本文提出KAT-GNN(知识增强型时间图神经网络),一种融合临床知识与时间动态的图基框架。首先从EHR构建模态特定患者图,再通过两个知识源增强:(1) 来自SNOMED CT的本体驱动边,(2) 从EHR中提取的共现先验。随后采用时序感知变换器捕捉图编码患者表示的纵向动态。在三个不同数据集与任务上评估:使用长庚研究数据库(CGRD)进行冠状动脉疾病(CAD)预测,以及在MIMIC-III和MIMIC-IV数据集上进行院内死亡预测。KAT-GNN在CAD预测中取得0.9269±0.0029的AUROC,优于现有方法;在MIMIC-III和MIMIC-IV上的死亡预测也分别达到0.9230±0.0070和0.8849±0.0089的高精度。消融实验表明,知识增强与时间建模均显著贡献性能提升。结果表明,将临床知识融入图表示并结合时序注意力机制,是一种有效且通用的风险预测方法。
原文摘要 · Abstract (English)
Clinical risk prediction using electronic health records (EHRs) is vital to facilitate timely interventions and clinical decision support. However, modeling heterogeneous and irregular temporal EHR data presents significant challenges. We propose \textbf{KAT-GNN} (Knowledge-Augmented Temporal Graph Neural Network), a graph-based framework that integrates clinical knowledge and temporal dynamics for risk prediction. KAT-GNN first constructs modality-specific patient graphs from EHRs. These graphs are then augmented using two knowledge sources: (1) ontology-driven edges derived from SNOMED CT and (2) co-occurrence priors extracted from EHRs. Subsequently, a time-aware transformer is employed to capture longitudinal dynamics from the graph-encoded patient representations. KAT-GNN is evaluated on three distinct datasets and tasks: coronary artery disease (CAD) prediction using the Chang Gung Research Database (CGRD) and in-hospital mortality prediction using the MIMIC-III and MIMIC-IV datasets. KAT-GNN achieves state-of-the-art performance in CAD prediction (AUROC: 0.9269 $\pm$ 0.0029) and demonstrated strong results in mortality prediction in MIMIC-III (AUROC: 0.9230 $\pm$ 0.0070) and MIMIC-IV (AUROC: 0.8849 $\pm$ 0.0089), consistently outperforming established baselines such as GRASP and RETAIN. Ablation studies confirm that both knowledge-based augmentation and the temporal modeling component are significant contributors to performance gains. These findings demonstrate that the integration of clinical knowledge into graph representations, coupled with a time-aware attention mechanism, provides an effective and generalizable approach for risk prediction across diverse clinical tasks and datasets.
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