用几何结构筛选临床预测候选,提升长期病程预判准确率。
Risk Horizons: Structured Hypothesis Spaces for Longitudinal Clinical Prediction
- 结合编码层级与数据驱动关联,构建患者特异性候选空间
- 在MIMIC-IV和eICU上实现更一致的诊断/操作/用药预测
- 适合需要精准长期临床预测的医疗AI研究者
从纵向电子健康记录(EHR)中预测未来临床事件,需在庞大且结构化的事件空间中挑选合理结果,但观测稀疏导致预测困难。尽管临床编码系统提供事件层级结构,跨模态与时间关系未显式定义,须从数据中推断,使弱观测的纵向转移预测复杂化。我们提出风险视界(Risk Horizons),一种几何感知框架,用于构建多模态下一次就诊的患者特定候选空间。该方法融合确定性编码层级与数据驱动的滞后跨模态关联,将所得临床图嵌入双曲空间,并利用方向性风险锥检索候选未来。此举将纵向预测转化为在紧凑、临床连贯假设空间内的排序,而非对无约束词汇表进行打分。在MIMIC-IV和eICU上的实验表明,该方法具备竞争力的下一次就诊预测性能,且在诊断、操作和药物方面均显著提升层级一致性。进一步分析显示,双曲结构候选检索是性能提升的主要原因,而大语言模型(LLMs)作为受约束的推理时重排序器,在临床基础候选集上表现良好。
原文摘要 · Abstract (English)
Predicting future clinical events from longitudinal electronic health records (EHRs) requires selecting plausible outcomes from a large and structured event space under sparse observations. While clinical coding systems provide hierarchical organization of events, cross-modal and temporal relationships are not explicitly specified and must instead be inferred from data, making prediction difficult for weakly observed longitudinal transitions. We introduce Risk Horizons, a geometry-aware framework for constructing patient-specific candidate spaces for multi-modal next-visit prediction. Risk Horizons combines deterministic coding hierarchies with data-driven lagged cross-modal associations, embeds the resulting clinical graph in hyperbolic space, and retrieves candidate futures using directional risk cones. This reframes longitudinal prediction as ranking within a compact, clinically coherent hypothesis space rather than scoring an unconstrained vocabulary. Experiments on MIMIC-IV and eICU demonstrate competitive next-visit prediction performance, with consistently improved hierarchy consistency across diagnoses, procedures, and medications. Further analysis suggests that hyperbolic structured candidate retrieval is the primary driver of performance, while LLMs are effective as constrained inference-time rerankers operating over clinically grounded candidate sets.
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