Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Sci Rep. 2020 Jan 24;10(1):1111. doi: 10.1038/s41598-020-58053-z.
To compare different deep learning architectures for predicting the risk of readmission within 30 days of discharge from the intensive care unit (ICU). The interpretability of attention-based models is leveraged to describe patients-at-risk. Several deep learning architectures making use of attention mechanisms, recurrent layers, neural ordinary differential equations (ODEs), and medical concept embeddings with time-aware attention were trained using publicly available electronic medical record data (MIMIC-III) associated with 45,298 ICU stays for 33,150 patients. Bayesian inference was used to compute the posterior over weights of an attention-based model. Odds ratios associated with an increased risk of readmission were computed for static variables. Diagnoses, procedures, medications, and vital signs were ranked according to the associated risk of readmission. A recurrent neural network, with time dynamics of code embeddings computed by neural ODEs, achieved the highest average precision of 0.331 (AUROC: 0.739, F-Score: 0.372). Predictive accuracy was comparable across neural network architectures. Groups of patients at risk included those suffering from infectious complications, with chronic or progressive conditions, and for whom standard medical care was not suitable. Attention-based networks may be preferable to recurrent networks if an interpretable model is required, at only marginal cost in predictive accuracy.
比较不同的深度学习架构,以预测从重症监护病房(ICU)出院后 30 天内再入院的风险。利用基于注意力的模型的可解释性来描述高危患者。使用公开的电子病历数据(MIMIC-III),对几种利用注意力机制、递归层、神经常微分方程(ODE)和具有时间感知注意力的医学概念嵌入的深度学习架构进行训练,这些数据与 33150 名患者的 45298 次 ICU 住院相关。使用贝叶斯推断来计算基于注意力的模型的权重后验。为静态变量计算与再入院风险增加相关的优势比。根据再入院风险对诊断、手术、药物和生命体征进行排序。具有由神经 ODE 计算的代码嵌入时间动态的递归神经网络,实现了最高的平均精度 0.331(AUROC:0.739,F 分数:0.372)。预测准确性在神经网络架构之间具有可比性。高危患者群体包括患有感染性并发症、患有慢性或进行性疾病且不适合标准医疗的患者。如果需要可解释的模型,基于注意力的网络可能比递归网络更可取,而在预测准确性方面仅略有成本。