提出可解释的重症监护死亡风险预测框架,兼顾时间敏感性与临床知识。
TA-RNN-Medical-Hybrid: A Time-Aware and Interpretable Framework for Mortality Risk Prediction
- 用连续时间嵌入建模不规则医疗记录,融合疾病概念知识
- 在MIMIC-III数据集上AUC、F2得分均优于基线模型
- 能分解风险来源,给出符合医学常识的时序解释,适合临床决策
重症监护中准确且可解释的死亡风险预测仍面临挑战,源于电子健康记录(EHR)的不规则时间结构、长期疾病轨迹的复杂性,以及多数数据驱动模型缺乏临床基础解释。本文提出TA-RNN-Medical-Hybrid框架,通过显式连续时间编码联合建模纵向临床序列与不规则时间动态,并引入标准化医学概念表示。该框架扩展了时间感知循环建模,集成独立于就诊索引的连续时间嵌入、基于SNOMED的疾病表示及分层双级注意力机制,同时捕捉就诊级别的时间重要性与特征/概念级别的临床相关性。实验在MIMIC-III重症数据集上进行,结果表明其在AUC、准确率和召回导向的F₂-score上持续优于强基准模型。定性分析显示,模型能有效分解风险随时间和临床概念的变化,揭示疾病严重程度、慢性特征与时间进程。整体而言,该框架弥合了预测准确性与临床可解释性之间的差距,为高风险重症监护决策支持系统提供可扩展、透明的解决方案。
原文摘要 · Abstract (English)
Accurate and interpretable mortality risk prediction in intensive care units (ICUs) remains a critical challenge due to the irregular temporal structure of electronic health records (EHRs), the complexity of longitudinal disease trajectories, and the lack of clinically grounded explanations in many data-driven models. To address these challenges, we propose \textit{TA-RNN-Medical-Hybrid}, a time-aware and knowledge-enriched deep learning framework that jointly models longitudinal clinical sequences and irregular temporal dynamics through explicit continuous-time encoding, along with standardized medical concept representations. The proposed framework extends time-aware recurrent modeling by integrating explicit continuous-time embeddings that operate independently of visit indexing, SNOMED-based disease representations, and a hierarchical dual-level attention mechanism that captures both visit-level temporal importance and feature/concept-level clinical relevance. This design enables accurate mortality risk estimation while providing transparent and clinically meaningful explanations aligned with established medical knowledge. We evaluate the proposed approach on the MIMIC-III critical care dataset and compare it against strong time-aware and sequential baselines. Experimental results demonstrate that TA-RNN-Medical-Hybrid consistently improves predictive performance in terms of AUC, accuracy, and recall-oriented F$_2$-score. Moreover, qualitative analysis shows that the model effectively decomposes mortality risk across time and clinical concepts, yielding interpretable insights into disease severity, chronicity, and temporal progression. Overall, the proposed framework bridges the gap between predictive accuracy and clinical interpretability, offering a scalable and transparent solution for high-stakes ICU decision support systems.
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