用深度核学习分析病历数据,区分青光眼患者进展风险
Deep Kernel Learning for Stratifying Glaucoma Trajectories

- 用基于Transformer的特征提取器构建高斯过程核函数
- 识别出三类患者,其中高危组虽视力较好但病情持续恶化
- 可帮助医生提前发现潜在进展风险,适合临床决策支持
在慢性病如青光眼的管理中,有效分层患者风险是重大临床挑战。医生需要工具从稀疏且不规则采样的电子健康记录(EHR)中识别高风险进展患者。我们提出一种新型深度核学习(DKL)架构,采用高斯过程(GP)作为后端,其核函数由基于Transformer的特征提取器定义,该提取器作用于临床-BERT嵌入,以建模多模态EHR数据中的青光眼患者轨迹。我们的方法成功识别出三类具有临床意义的患者亚群。关键的是,模型能够将疾病进展与当前严重程度解耦,识别出一个尽管平均视功能优于另一稳定差的群体,但轨迹仍在恶化的高风险组。这表明模型学习到的是进展风险而非仅当前疾病状态。基于风险轨迹的分层能力为临床决策支持提供了有力工具,有助于对高风险个体实施针对性干预,提升青光眼管理效果。
原文摘要 · Abstract (English)
Effectively stratifying patient risk in chronic diseases like glaucoma is a major clinical challenge. Clinicians need tools to identify patients at high risk of progression from sparse and irregularly-sampled electronic health records (EHRs). We propose a novel deep kernel learning (DKL) architecture that leverages a Gaussian Process (GP) backend. The GP's kernel is defined by a transformer-based feature extractor applied to clinical-BERT embeddings to model glaucoma patient trajectories from multimodal EHR data. Our method successfully identifies three clinically distinct patient subgroups. Crucially, the model learns to decouple disease progression from current severity, identifying a high-risk group with a worsening trajectory despite having better average visual acuity than a second, stably poor group. This reveals that the model learns to identify progression risk rather than just the current disease state. This ability to stratify patients based on their risk trajectory progression offers a powerful tool for clinical decision support, enabling targeted interventions for high-risk individuals and improving the management of glaucoma care.
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