The development of respiratory failure is common among patients in intensive care units (ICU). Large data quantities from ICU patient monitoring systems make timely and comprehensive analysis by clinicians difficult but are ideal for automatic processing by machine learning algorithms. Early prediction of respiratory system failure could alert clinicians to patients at risk of respiratory failure and allow for early patient reassessment and treatment adjustment. We propose an early warning system that predicts moderate/severe respiratory failure up to 8 hours in advance. Our system was trained on HiRID-II, a data-set containing more than 60,000 admissions to a tertiary care ICU. An alarm is typically triggered several hours before the beginning of respiratory failure. Our system outperforms a clinical baseline mimicking traditional clinical decision-making based on pulse-oximetric oxygen saturation and the fraction of inspired oxygen. To provide model introspection and diagnostics, we developed an easy-to-use web browser-based system to explore model input data and predictions visually.

Dynamic assessment of mortality risk in the intensive care unit (ICU) can be used to stratify patients, inform about treatment effectiveness or serve as part of an early-warning system. Static risk scoring systems, such as APACHE or SAPS, have recently been supplemented with data-driven approaches that track the dynamic mortality risk over time. Recent works have focused on enhancing the information delivered to clinicians even further by producing full survival distributions instead of point predictions or fixed horizon risks. In this work, we propose a non-parametric ensemble model, Weighted Resolution Survival Ensemble (WRSE), tailored to estimate such dynamic individual survival distributions. Inspired by the simplicity and robustness of ensemble methods, the proposed approach combines a set of binary classifiers spaced according to a decay function reflecting the relevance of short-term mortality predictions. Models and baselines are evaluated under weighted calibration and discrimination metrics for individual survival distributions which closely reflect the utility of a model in ICU practice. We show competitive results with state-of-the-art probabilistic models, while greatly reducing training time by factors of 2-9x.

Generating visualizations and interpretations from high-dimensional data is a common problem in many fields. Two key approaches for tackling this problem are clustering and representation learning. There are very performant deep clustering models on the one hand and interpretable representation learning techniques, often relying on latent topological structures such as self-organizing maps, on the other hand. However, current methods do not yet successfully combine these two approaches. We present a new deep architecture for probabilistic clustering, VarPSOM, and its extension to time series data, VarTPSOM. We show that they achieve superior clustering performance compared to current deep clustering methods on static MNIST/Fashion-MNIST data as well as medical time series, while inducing an interpretable representation. Moreover, on the medical time series, VarTPSOM successfully predicts future trajectories in the original data space.

Intensive care clinicians are presented with large quantities of patient information and measurements from a multitude of monitoring systems. The limited ability of humans to process such complex information hinders physicians to readily recognize and act on early signs of patient deterioration. We used machine learning to develop an early warning system for circulatory failure based on a high-resolution ICU database with 240 patient years of data. This automatic system predicts 90.0% of circulatory failure events (prevalence 3.1%), with 81.8% identified more than two hours in advance, resulting in an area under the receiver operating characteristic curve of 94.0% and area under the precision-recall curve of 63.0%. The model was externally validated in a large independent patient cohort.

Human professionals are often required to make decisions based on complex multivariate time series measurements in an online setting, e.g. in health care. Since human cognition is not optimized to work well in high-dimensional spaces, these decisions benefit from interpretable low-dimensional representations. However, many representation learning algorithms for time series data are difficult to interpret. This is due to non-intuitive mappings from data features to salient properties of the representation and non-smoothness over time. To address this problem, we propose to couple a variational autoencoder to a discrete latent space and introduce a topological structure through the use of self-organizing maps. This allows us to learn discrete representations of time series, which give rise to smooth and interpretable embeddings with superior clustering performance. Furthermore, to allow for a probabilistic interpretation of our method, we integrate a Markov model in the latent space. This model uncovers the temporal transition structure, improves clustering performance even further and provides additional explanatory insights as well as a natural representation of uncertainty. We evaluate our model on static (Fashion-)MNIST data, a time series of linearly interpolated (Fashion-)MNIST images, a chaotic Lorenz attractor system with two macro states, as well as on a challenging real world medical time series application. In the latter experiment, our representation uncovers meaningful structure in the acute physiological state of a patient.