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ABSTRACT Understanding clinical trajectories of sepsis patients is crucial for prognostication, resource planning, and to inform digital twin models of critical illness. This study aims to identify common clinical trajectories based on dynamic assessment of cardiorespiratory support using a validated electronic health record data that covers retrospective cohort of 19,177 patients with sepsis admitted to intensive care units (ICUs) of Mayo Clinic Hospitals over 8-year period. Patient trajectories were modeled from ICU admission up to 14 days using an unsupervised machine learning two-stage clustering method based on cardiorespiratory support in ICU and hospital discharge status. Of 19,177 patients, 42% were female with a median age of 65 (interquartile range [IQR], 55–76) years, The Acute Physiology, Age, and Chronic Health Evaluation III score of 70 (IQR, 56–87), hospital length of stay (LOS) of 7 (IQR, 4–12) days, and ICU LOS of 2 (IQR, 1–4) days. Four distinct trajectories were identified: fast recovery (27% with a mortality rate of 3.5% and median hospital LOS of 3 (IQR, 2–15) days), slow recovery (62% with a mortality rate of 3.6% and hospital LOS of 8 (IQR, 6–13) days), fast decline (4% with a mortality rate of 99.7% and hospital LOS of 1 (IQR, 0–1) day), and delayed decline (7% with a mortality rate of 97.9% and hospital LOS of 5 (IQR, 3–8) days). Distinct trajectories remained robust and were distinguished by Charlson Comorbidity Index, The Acute Physiology, Age, and Chronic Health Evaluation III scores, as well as day 1 and day 3 SOFA (P< 0.001 ANOVA). These findings provide a foundation for developing prediction models and digital twin decision support tools, improving both shared decision making and resource planning.
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Learning Electronic Health Records through Hyperbolic Embedding of Medical Ontologies
Unplanned intensive care units (ICU) readmissions and in-hospital mortality of patients are two important metrics for evaluating the quality of hospital care. Identifying patients with higher risk of readmission to ICU or of mortality can not only protect those patients from potential dangers, but also reduce the high costs of healthcare. In this work, we propose a new method to incorporate information from the Electronic Health Records (EHRs) of patients and utilize hyperbolic embeddings of a medical ontology (i.e., ICD-9) in the prediction model. The results prove the effectiveness of our method and show that hyperbolic embeddings of ontological concepts give promising performance.
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- Award ID(s):
- 1747798
- PAR ID:
- 10131156
- Date Published:
- Journal Name:
- Proceedings of the 10th ACM International Conference on Bioinformatics, Computational Biology and Health Informatics
- Page Range / eLocation ID:
- 338 to 346
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Conference Paper:
- https://doi.org/10.1145/3307339.3342148
