With advances in high-throughput technology, molecular disease subtyping by high-dimensional omics data has been recognized as an effective approach for identifying subtypes of complex diseases with distinct disease mechanisms and prognoses. Conventional cluster analysis takes omics data as input and generates patient clusters with similar gene expression pattern. The omics data, however, usually contain multifaceted cluster structures that can be defined by different sets of genes. If the gene set associated with irrelevant clinical variables (e.g., sex or age) dominates the clustering process, the resulting clusters may not capture clinically meaningful disease subtypes. This motivates the development of a clustering framework with guidance from a prespecified disease outcome, such as lung function measurement or survival, in this paper. We propose two disease subtyping methods by omics data with outcome guidance using a generative model or a weighted joint likelihood. Both methods connect an outcome association model and a disease subtyping model by a latent variable of cluster labels. Compared to the generative model, weighted joint likelihood contains a data-driven weight parameter to balance the likelihood contributions from outcome association and gene cluster separation, which improves generalizability in independent validation but requires heavier computing. Extensive simulations and two real applications in lung disease and triple-negative breast cancer demonstrate superior disease subtyping performance of the outcome-guided clustering methods in terms of disease subtyping accuracy, gene selection and outcome association. Unlike existing clustering methods, the outcome-guided disease subtyping framework creates a new precision medicine paradigm to directly identify patient subgroups with clinical association.
more »
« less
Temporal Clustering with External Memory Network for Disease Progression Modeling
We have developed a Temporal Clustering with External Memory Network (TC-EMNet) for disease progression modeling that groups patients with similar trajectories to form disease clusters/stages. Experiments on two real-world datasets show that our model demonstrates competitive clustering performance against state-of-the-art methods and is able to identify clinically meaningful clusters. The visualization of the extracted patient states shows that the proposed model can generate better patient states than the baselines.
more »
« less
- Award ID(s):
- 2037398
- PAR ID:
- 10312658
- Date Published:
- Journal Name:
- Proceedings ICDM workshops
- ISSN:
- 2375-9259
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Keim-Malpass, Jessica (Ed.)During the early stages of hospital admission, clinicians use limited information to make decisions as patient acuity evolves. We hypothesized that clustering analysis of vital signs measured within six hours of hospital admission would reveal distinct patient phenotypes with unique pathophysiological signatures and clinical outcomes. We created a longitudinal electronic health record dataset for 75,762 adult patient admissions to a tertiary care center in 2014–2016 lasting six hours or longer. Physiotypes were derived via unsupervised machine learning in a training cohort of 41,502 patients applying consensus k -means clustering to six vital signs measured within six hours of admission. Reproducibility and correlation with clinical biomarkers and outcomes were assessed in validation cohort of 17,415 patients and testing cohort of 16,845 patients. Training, validation, and testing cohorts had similar age (54–55 years) and sex (55% female), distributions. There were four distinct clusters. Physiotype A had physiologic signals consistent with early vasoplegia, hypothermia, and low-grade inflammation and favorable short-and long-term clinical outcomes despite early, severe illness. Physiotype B exhibited early tachycardia, tachypnea, and hypoxemia followed by the highest incidence of prolonged respiratory insufficiency, sepsis, acute kidney injury, and short- and long-term mortality. Physiotype C had minimal early physiological derangement and favorable clinical outcomes. Physiotype D had the greatest prevalence of chronic cardiovascular and kidney disease, presented with severely elevated blood pressure, and had good short-term outcomes but suffered increased 3-year mortality. Comparing sequential organ failure assessment (SOFA) scores across physiotypes demonstrated that clustering did not simply recapitulate previously established acuity assessments. In a heterogeneous cohort of hospitalized patients, unsupervised machine learning techniques applied to routine, early vital sign data identified physiotypes with unique disease categories and distinct clinical outcomes. This approach has the potential to augment understanding of pathophysiology by distilling thousands of disease states into a few physiological signatures.more » « less
-
Heterogeneity among Alzheimer’s disease (AD) patients confounds clinical trial patient selection and therapeutic efficacy evaluation. This work defines separable AD clinical sub-populations using unsupervised machine learning. Clustering (t-SNE followed by k-means) of patient features and association rule mining (ARM) was performed on the ADNIMERGE dataset from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Patient sociodemographics, brain imaging, biomarkers, cognitive tests, and medication usage were included for analysis. Four AD clinical sub-populations were identified using between-cluster mean fold changes [cognitive performance, brain volume]: cluster-1 represented least severe disease [+17.3, +13.3]; cluster-0 [−4.6, +3.8] and cluster-3 [+10.8, −4.9] represented mid-severity sub-populations; cluster-2 represented most severe disease [−18.4, −8.4]. ARM assessed frequently occurring pharmacologic substances within the 4 sub-populations. No drug class was associated with the least severe AD (cluster-1), likely due to lesser antecedent disease. Anti-hyperlipidemia drugs associated with cluster-0 (mid-severity, higher volume). Interestingly, antioxidants vitamin C and E associated with cluster-3 (mid-severity, higher cognition). Anti-depressants like Zoloft associated with most severe disease (cluster-2). Vitamin D is protective for AD, but ARM identified significant underutilization across all AD sub-populations. Identification and feature characterization of four distinct AD sub-population “clusters” using standard clinical features enhances future clinical trial selection criteria and cross-study comparative analysis.more » « less
-
Traditional implementations of federated learning for preserving data privacy are unsuitable for longitudinal health data. To remedy this, we develop a federated enhanced fuzzy c-means clustering (FeFCM) algorithm that can identify groups of patients based on complex behavioral intervention responses. FeFCM calculates a global cluster model by incorporating data from multiple healthcare institutions without requiring patient observations to be shared. We evaluate FeFCM on simulated clusters as well as empirical data from four different dietary health studies in Massachusetts. Results find that FeFCM converges rapidly and achieves desirable clustering performance. As a result, FeFCM can promote pattern recognition in longitudinal health studies across hundreds of collaborating healthcare institutions while ensuring patient privacy.more » « less
-
Objective: Evaluate the effectiveness of machine learning tools that incorporate spatial information such as disease location and lymph node metastatic patterns-of-spread, for prediction of survival and toxicity in HPV+ oropharyngeal cancer (OPC). Materials & methods: 675 HPV+ OPC patients that were treated at MD Anderson Cancer Center between 2005 and 2013 with curative intent IMRT were retrospectively collected under IRB approval. Risk stratifications incorporating patient radiometric data and lymph node metastasis patterns via an anatomically-adjacent representation with hierarchical clustering were identified. These clusterings were combined into a 3-level patient stratification and included along with other known clinical features in a Cox model for predicting survival outcomes, and logistic regression for toxicity, using independent subsets for training and validation. Results: Four groups were identified and combined into a 3-level stratification. The inclusion of patient stratifications in predictive models for 5-yr Overall survival (OS), 5-year recurrence free survival, (RFS) and Radiation-associated dysphagia (RAD) consistently improved model performance measured using the area under the curve (AUC). Test set AUC improvements over models with clinical covariates, was 9 % for predicting OS, and 18 % for predicting RFS, and 7 % for predicting RAD. For models with both clinical and AJCC covariates, AUC improvement was 7 %, 9 %, and 2 % for OS, RFS, and RAD, respectively. Conclusion: Including data-driven patient stratifications considerably improve prognosis for survival and toxicity outcomes over the performance achieved by clinical staging and clinical covariates alone. These stratifications generalize well to across cohorts, and sufficient information for reproducing these clusters is included.more » « less
An official website of the United States government

