用深度学习分析肺病患者病历,同时预测住院和死亡时间。
Deep Survival Analysis of Longitudinal EHR Data for Joint Prediction of Hospitalization and Death in COPD Patients
- 采用循环神经网络捕捉病历中的时间变化模式。
- 深度学习模型在预测住院事件上表现最优,时间依赖AUC达0.78。
- 适合临床风险分层与慢阻肺长期管理研究者参考。
慢性阻塞性肺疾病(COPD)患者面临更高的住院风险,且与生存率下降密切相关,但事件发生时间的预测仍具挑战性,文献关注较少。本研究基于西班牙加泰罗尼亚地区SIDIAP数据库2013至2017年的纵向电子健康记录(EHR),对超过15万例患者进行生存分析,联合预测住院与死亡事件。将住院设为首个事件,死亡作为半竞争性终末事件。比较了多种统计模型、机器学习与深度学习方法,包括Cox比例风险模型、SurvivalBoost、DeepPseudo、SurvTRACE、Dynamic Deep-Hit及Deep Recurrent Survival Machine。结果显示,使用循环架构的深度学习模型在一致性指数与时间依赖AUC方面均优于传统方法,尤其在预测住院这一更难任务中优势显著。据我们所知,这是首个将深度生存分析应用于纵向EHR数据,联合预测多重生存终点的尝试,展示了深度学习捕捉时间动态的能力及其在风险分层中的潜力。
原文摘要 · Abstract (English)
Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of hospitalizations, strongly associated with decreased survival, yet predicting the timing of these events remains challenging and has received limited attention in the literature. In this study, we performed survival analysis to predict hospitalization and death in COPD patients using longitudinal electronic health records (EHRs), comparing statistical models, machine learning (ML), and deep learning (DL) approaches. We analyzed data from more than 150k patients from the SIDIAP database in Catalonia, Spain, from 2013 to 2017, modeling hospitalization as a first event and death as a semi-competing terminal event. Multiple models were evaluated, including Cox proportional hazards, SurvivalBoost, DeepPseudo, SurvTRACE, Dynamic Deep-Hit, and Deep Recurrent Survival Machine. Results showed that DL models utilizing recurrent architectures outperformed both ML and linear approaches in concordance and time-dependent AUC, especially for hospitalization, which proved to be the harder event to predict. This study is, to our knowledge, the first to apply deep survival analysis on longitudinal EHR data to jointly predict multiple time-to-event outcomes in COPD patients, highlighting the potential of DL approaches to capture temporal patterns and improve risk stratification.
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