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利用合成电子健康记录数据和深度学习通过预测接近灾难性失代偿来改善高危心力衰竭手术干预的时机

The Use of Synthetic Electronic Health Record Data and Deep Learning to Improve Timing of High-Risk Heart Failure Surgical Intervention by Predicting Proximity to Catastrophic Decompensation.

作者信息

Guo Aixia, Foraker Randi E, MacGregor Robert M, Masood Faraz M, Cupps Brian P, Pasque Michael K

机构信息

Institute for Informatics (I2), Washington University School of Medicine, St. Louis, MO, United States.

Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States.

出版信息

Front Digit Health. 2020 Dec 7;2:576945. doi: 10.3389/fdgth.2020.576945. eCollection 2020.


DOI:10.3389/fdgth.2020.576945
PMID:34713050
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8521851/
Abstract

Although many clinical metrics are associated with proximity to decompensation in heart failure (HF), none are individually accurate enough to risk-stratify HF patients on a patient-by-patient basis. The dire consequences of this inaccuracy in risk stratification have profoundly lowered the clinical threshold for application of high-risk surgical intervention, such as ventricular assist device placement. Machine learning can detect non-intuitive classifier patterns that allow for innovative combination of patient feature predictive capability. A machine learning-based clinical tool to identify proximity to catastrophic HF deterioration on a patient-specific basis would enable more efficient direction of high-risk surgical intervention to those patients who have the most to gain from it, while sparing others. electronic health record (EHR) data are statistically indistinguishable from the original protected health information, and can be analyzed as if they were original data but without any privacy concerns. We demonstrate that EHR data can be easily accessed and analyzed and are amenable to machine learning analyses. We developed data from EHR data of 26,575 HF patients admitted to a single institution during the decade ending on 12/31/2018. Twenty-seven clinically-relevant features were synthesized and utilized in supervised deep learning and machine learning algorithms (i.e., deep neural networks [DNN], random forest [RF], and logistic regression [LR]) to explore their ability to predict 1-year mortality by five-fold cross validation methods. We conducted analyses leveraging features from prior to/at and after/at the time of HF diagnosis. The area under the receiver operating curve (AUC) was used to evaluate the performance of the three models: the mean AUC was 0.80 for DNN, 0.72 for RF, and 0.74 for LR. Age, creatinine, body mass index, and blood pressure levels were especially important features in predicting death within 1-year among HF patients. Machine learning models have considerable potential to improve accuracy in mortality prediction, such that high-risk surgical intervention can be applied only in those patients who stand to benefit from it. Access to EHR-based synthetic data derivatives eliminates risk of exposure of EHR data, speeds time-to-insight, and facilitates data sharing. As more clinical, imaging, and contractile features with proven predictive capability are added to these models, the development of a clinical tool to assist in timing of intervention in surgical candidates may be possible.

摘要

尽管许多临床指标与心力衰竭(HF)患者接近失代偿的情况相关,但没有一个指标能单独准确到足以对每个HF患者进行风险分层。风险分层不准确带来的严重后果已大大降低了高风险手术干预(如植入心室辅助装置)的临床应用门槛。机器学习可以检测出非直观的分类模式,从而实现患者特征预测能力的创新组合。一种基于机器学习的临床工具,能够针对特定患者识别接近灾难性HF恶化的情况,这将使高风险手术干预更有效地针对那些能从中获益最大的患者,同时避免其他患者接受不必要的手术。电子健康记录(EHR)数据在统计学上与原始受保护的健康信息无法区分,可以像分析原始数据一样进行分析,而无需担心隐私问题。我们证明EHR数据可以轻松获取和分析,并且适合进行机器学习分析。我们开发了来自2018年12月31日之前十年间入住单一机构的26575例HF患者的EHR数据。合成了27个临床相关特征,并将其用于监督深度学习和机器学习算法(即深度神经网络[DNN])、随机森林[RF]和逻辑回归[LR]),通过五折交叉验证方法探索它们预测1年死亡率的能力。我们利用HF诊断之前/之时以及之后/之时的特征进行了分析。采用受试者工作特征曲线(AUC)下的面积来评估这三种模型的性能:DNN的平均AUC为0.80,RF为0.72,LR为0.74。年龄、肌酐、体重指数和血压水平是预测HF患者1年内死亡的特别重要的特征。机器学习模型在提高死亡率预测准确性方面具有相当大的潜力,这样高风险手术干预就可以仅应用于那些有望从中受益的患者。获取基于EHR的合成数据衍生物消除了EHR数据暴露的风险,加快了洞察时间,并促进了数据共享。随着更多具有已证实预测能力的临床、影像和收缩特征被添加到这些模型中,开发一种有助于确定手术候选者干预时机的临床工具可能成为现实。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/12d3283a80e0/fdgth-02-576945-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/e84a6153a3c4/fdgth-02-576945-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/5bef3237260f/fdgth-02-576945-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/00841d3b1715/fdgth-02-576945-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/12d3283a80e0/fdgth-02-576945-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/e84a6153a3c4/fdgth-02-576945-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/5bef3237260f/fdgth-02-576945-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/00841d3b1715/fdgth-02-576945-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe3/8521851/12d3283a80e0/fdgth-02-576945-g0004.jpg

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本文引用的文献

[1]
Spot the difference: comparing results of analyses from real patient data and synthetic derivatives.

JAMIA Open. 2020-12-14

[2]
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Eur J Heart Fail. 2020-1

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JACC Heart Fail. 2020-1

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PLoS One. 2019-7-8

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ESC Heart Fail. 2019-2-27

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