用多模态深度学习预测肝移植后早期移植物抗宿主病,提升预警准确率。
Early GVHD Prediction in Liver Transplantation via Multi-Modal Deep Learning on Imbalanced EHR Data
- 融合患者人口统计、检验、诊断和用药四类医疗数据,动态建模互补信息。
- 在42例GVHD/2100例患者数据上达AUC 0.836,召回率76.8%。
- 适合临床预警系统开发,尤其关注罕见病早期识别的医疗AI研究者。
移植物抗宿主病(GVHD)是肝移植后一种罕见但常致命的并发症,死亡率极高。本研究利用多模态深度学习方法整合异构且极度不平衡的电子健康记录(EHR),旨在实现GVHD的早期预测,为及时干预和改善预后提供支持。分析了来自梅奥诊所1992至2025年间2,100名肝移植患者的术前EHR数据,其中包含42例GVHD病例。数据涵盖四大模态:患者人口学特征、实验室检查、诊断信息和用药记录。我们提出一种多模态深度学习框架,可动态融合多源数据,处理不规则记录与缺失值,并通过基于AUC的优化应对极端类别不平衡问题。该框架显著优于所有单模态及多模态机器学习基线,达到AUC 0.836、AUPRC 0.157、召回率0.768、特异性0.803。结果表明,该方法有效捕捉了不同模态间的互补信息,显著提升预测性能。该框架在真实世界中处理异质性和极端不平衡的EHR数据方面表现优异,为肝移植后早期GVHD预测提供了强有力工具。
原文摘要 · Abstract (English)
Graft-versus-host disease (GVHD) is a rare but often fatal complication in liver transplantation, with a very high mortality rate. By harnessing multi-modal deep learning methods to integrate heterogeneous and imbalanced electronic health records (EHR), we aim to advance early prediction of GVHD, paving the way for timely intervention and improved patient outcomes. In this study, we analyzed pre-transplant electronic health records (EHR) spanning the period before surgery for 2,100 liver transplantation patients, including 42 cases of graft-versus-host disease (GVHD), from a cohort treated at Mayo Clinic between 1992 and 2025. The dataset comprised four major modalities: patient demographics, laboratory tests, diagnoses, and medications. We developed a multi-modal deep learning framework that dynamically fuses these modalities, handles irregular records with missing values, and addresses extreme class imbalance through AUC-based optimization. The developed framework outperforms all single-modal and multi-modal machine learning baselines, achieving an AUC of 0.836, an AUPRC of 0.157, a recall of 0.768, and a specificity of 0.803. It also demonstrates the effectiveness of our approach in capturing complementary information from different modalities, leading to improved performance. Our multi-modal deep learning framework substantially improves existing approaches for early GVHD prediction. By effectively addressing the challenges of heterogeneity and extreme class imbalance in real-world EHR, it achieves accurate early prediction. Our proposed multi-modal deep learning method demonstrates promising results for early prediction of a GVHD in liver transplantation, despite the challenge of extremely imbalanced EHR data.
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