Estimating patient's clinical state from multiple concurrent physiological streams plays an important role in determining if a therapeutic intervention is necessary and for triaging patients in the hospital. In this paper we construct a non-parametric learning algorithm to estimate the clinical state of a patient. The algorithm addresses several known challenges with clinical state estimation such as eliminating bias introduced by therapeutic intervention censoring, increasing the timeliness of state estimation while ensuring a sufficient accuracy, and the ability to detect anomalous clinical states. These benefits are obtained by combining the tools of non-parametric Bayesian inference, permutation testing, and generalizations of the empirical Bernstein inequality. The algorithm is validated using real-world data from a cancer ward in a large academic hospital.

In this paper we construct a non-parametric learning algorithm to estimate the clinical state of a patient.

Patients with acute kidney injury (AKI) are at high risk of developing chronic kidney disease (CKD), but identifying those at greatest risk remains challenging. We used electronic health record (EHR) data to dynamically track AKI patients' clinical evolution and characterize AKI-to-CKD progression. Post-AKI clinical states were identified by clustering patient vectors derived from longitudinal medical codes and creatinine measurements. Transition probabilities between states and progression to CKD were estimated using multi-state modeling. After identifying common post-AKI trajectories, CKD risk factors in AKI subpopulations were identified through survival analysis. Of 20,699 patients with AKI at admission, 3,491 (17%) developed CKD. We identified fifteen distinct post-AKI states, each with different probabilities of CKD development. Most patients (75%, n=15,607) remained in a single state or made only one transition during the study period. Both established (e.g., AKI severity, diabetes, hypertension, heart failure, liver disease) and novel CKD risk factors, with their impact varying across these clinical states. This study demonstrates a data-driven approach for identifying high-risk AKI patients, supporting the development of decision-support tools for early CKD detection and intervention.

Estimating patient's clinical state from multiple concurrent physiological streams plays an important role in determining if a therapeutic intervention is necessary and for triaging patients in the hospital. In this paper we construct a non-parametric learning algorithm to estimate the clinical state of a patient. The algorithm addresses several known challenges with clinical state estimation such as eliminating the bias introduced by therapeutic intervention censoring, increasing the timeliness of state estimation while ensuring a sufficient accuracy, and the ability to detect anomalous clinical states. These benefits are obtained by combining the tools of non-parametric Bayesian inference, permutation testing, and generalizations of the empirical Bernstein inequality. The algorithm is validated using real-world data from a cancer ward in a large academic hospital.

Reprints will not be available from the author(s). ABSTRACT Objectives: We hypothesize that multistate models are beneficial in analyzing transitions through kidney states and understanding the underlying processes influencing the course of kidney health. Specifically, we aim to quantify longitudinal acute kidney injury (AKI) trajectories and to describe transitions through progressing and recovery states and outcomes among hospitalized patients. Methods: In this large, longitudinal cohort study, 138,449 adult patients admitted to a quaternary care hospital between January 2012 and August 2019 were staged based on Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria as No AKI, Stage 1, Stage 2, Stage 3, and Stage 3 with renal replacement therapy (RRT) AKI for the first 14 days of their hospital stay. We fit and examined multistate models to estimate probability of being in a certain clinical state at a given time after entering each one of the AKI stages. We investigated the effects of age, sex, race, admission comorbidities, and prolonged intensive care unit (ICU) stay on transition rates via Cox proportional hazards regression models. Results: Twenty percent of hospitalized encounters (49,325/246,964) had AKI; among patients with AKI, 66% (n = 32,739) had Stage 1 AKI, 18% (n = 8,670) had Stage 2 AKI, and 17% (n = 7,916) had AKI Stage 3 with or without RRT.

Diagnosing Alzheimer's disease (AD) involves a deliberate diagnostic process owing to its innate traits of irreversibility with subtle and gradual progression. These characteristics make AD biomarker identification from structural brain imaging (e.g., structural MRI) scans quite challenging. Furthermore, there is a high possibility of getting entangled with normal aging. We propose a novel deep-learning approach through eXplainable AD Likelihood Map Estimation (XADLiME) for AD progression modeling over 3D sMRIs using clinically-guided prototype learning. Specifically, we establish a set of topologically-aware prototypes onto the clusters of latent clinical features, uncovering an AD spectrum manifold. We then measure the similarities between latent clinical features and well-established prototypes, estimating a "pseudo" likelihood map. By considering this pseudo map as an enriched reference, we employ an estimating network to estimate the AD likelihood map over a 3D sMRI scan. Additionally, we promote the explainability of such a likelihood map by revealing a comprehensible overview from two perspectives: clinical and morphological. During the inference, this estimated likelihood map served as a substitute over unseen sMRI scans for effectively conducting the downstream task while providing thorough explainable states.

Estimating patient's clinical state from multiple concurrent physiological streams plays an important role in determining if a therapeutic intervention is necessary and for triaging patients in the hospital. In this paper we construct a non-parametric learning algorithm to estimate the clinical state of a patient. The algorithm addresses several known challenges with clinical state estimation such as eliminating bias introduced by therapeutic intervention censoring, increasing the timeliness of state estimation while ensuring a sufficient accuracy, and the ability to detect anomalous clinical states. These benefits are obtained by combining the tools of non-parametric Bayesian inference, permutation testing, and generalizations of the empirical Bernstein inequality. The algorithm is validated using real-world data from a cancer ward in a large academic hospital.

Modeling continuous-time physiological processes that manifest a patient's evolving clinical states is a key step in approaching many problems in healthcare. In this paper, we develop the Hidden Absorbing Semi-Markov Model (HASMM): a versatile probabilistic model that is capable of capturing the modern electronic health record (EHR) data. Unlike existing models, the HASMM accommodates irregularly sampled, temporally correlated, and informatively censored physiological data, and can describe non-stationary clinical state transitions. Learning the HASMM parameters from the EHR data is achieved via a novel forward-filtering backward-sampling Monte-Carlo EM algorithm that exploits the knowledge of the endpoint clinical outcomes (informative censoring) in the EHR data, and implements the E-step by sequentially sampling the patients' clinical states in the reversetime direction while conditioning on the future states. Real-time inferences are drawn via a forward-filtering algorithm that operates on a virtually constructed discrete-time embedded Markov chain that mirrors the patient's continuous-time state trajectory. We demonstrate the prognostic utility of the HASMM in a critical care prognosis setting using a real-world dataset for patients admitted to the Ronald Reagan UCLA Medical Center. In particular, we show that using HASMMs, a patient's clinical deterioration can be predicted 8-9 hours prior to intensive care unit admission, with a 22% AUC gain compared to the Rothman index, which is the state-of-the-art critical care risk scoring technology.