Sepsis is a lethal syndrome of organ dysfunction that is triggered by an infection and claims 11 million lives per year globally. Prognostic algorithms based on deep learning have shown promise in detecting the onset of sepsis hours before the actual event but use a large number of bio-markers, including vital signs and laboratory tests. The latter makes the deployment of such systems outside hospitals or in resource-limited environments extremely challenging. This paper introduces SepAl, an energy-efficient and lightweight neural network, using only data from low-power wearable sensors, such as photoplethysmography (PPG), inertial measurement units (IMU), and body temperature sensors, designed to deliver alerts in real-time. SepAl leverages only six digitally acquirable vital signs and tiny machine learning algorithms, enabling on-device real-time sepsis prediction. SepAl uses a lightweight temporal convolution neural network capable of providing sepsis alerts with a median predicted time to sepsis of 9.8 hours. The model has been fully quantized, being able to be deployed on any low-power processors, and evaluated on an ARM Cortex-M33 core. Experimental evaluations show an inference efficiency of 0.11MAC/Cycle and a latency of 143ms, with an energy per inference of 2.68mJ. This work aims at paving the way toward accurate disease prediction, deployable in a long-lasting multi-vital sign wearable device, suitable for providing sepsis onset alerts at the point of care. The code used in this work has been open-sourced and is available at https://github.com/mgiordy/sepsis-prediction

Sepsis is a syndrome that develops in the body in response to the presence of an infection. Characterized by severe organ dysfunction, sepsis is one of the leading causes of mortality in Intensive Care Units (ICUs) worldwide. These complications can be reduced through early application of antibiotics. Hence, the ability to anticipate the onset of sepsis early is crucial to the survival and well-being of patients. Current machine learning algorithms deployed inside medical infrastructures have demonstrated poor performance and are insufficient for anticipating sepsis onset early. Recently, deep learning methodologies have been proposed to predict sepsis, but some fail to capture the time of onset (e.g., classifying patients' entire visits as developing sepsis or not) and others are unrealistic for deployment in clinical settings (e.g., creating training instances using a fixed time to onset, where the time of onset needs to be known apriori). In this paper, we first propose a novel but realistic prediction framework that predicts each morning whether sepsis onset will occur within the next 24 hours using the most recent data collected the previous night, when patient-provider ratios are higher due to cross-coverage resulting in limited observation to each patient. However, as we increase the prediction rate into daily, the number of negative instances will increase, while that of positive instances remain the same. This causes a severe class imbalance problem making it hard to capture these rare sepsis cases. To address this, we propose a nightly profile representation learning (NPRL) approach. We prove that NPRL can theoretically alleviate the rare event problem and our empirical study using data from a level-1 trauma center demonstrates the effectiveness of our proposal.

The timeliness of detection of a sepsis event in progress is a crucial factor in the outcome for the patient. Machine learning models built from data in electronic health records can be used as an effective tool for improving this timeliness, but so far the potential for clinical implementations has been largely limited to studies in intensive care units. This study will employ a richer data set that will expand the applicability of these models beyond intensive care units. Furthermore, we will circumvent several important limitations that have been found in the literature: 1) Models are evaluated shortly before sepsis onset without considering interventions already initiated. 2) Machine learning models are built on a restricted set of clinical parameters, which are not necessarily measured in all departments. 3) Model performance is limited by current knowledge of sepsis, as feature interactions and time dependencies are hardcoded into the model. In this study, we present a model to overcome these shortcomings using a deep learning approach on a diverse multicenter data set. We used retrospective data from multiple Danish hospitals over a seven-year period. Our sepsis detection system is constructed as a combination of a convolutional neural network and a long short-term memory network. We suggest a retrospective assessment of interventions by looking at intravenous antibiotics and blood cultures preceding the prediction time. Results show performance ranging from AUROC 0.856 (3 hours before sepsis onset) to AUROC 0.756 (24 hours before sepsis onset). We present a deep learning system for early detection of sepsis that is able to learn characteristics of the key factors and interactions from the raw event sequence data itself, without relying on a labor-intensive feature extraction work.

Motivation: Sepsis is a life-threatening host response to infection associated with high mortality, morbidity and health costs. Its management is highly time-sensitive since each hour of delayed treatment increases mortality due to irreversible organ damage. Meanwhile, despite decades of clinical research robust biomarkers for sepsis are missing. Therefore, detecting sepsis early by utilizing the affluence of high-resolution intensive care records has become a challenging machine learning problem. Recent advances in deep learning and data mining promise a powerful set of tools to efficiently address this task. Results: This paper proposes two approaches for the early detection of sepsis: a new deep learning model (MGP-TCN) and a data mining model (DTW-KNN). MGP-TCN employs a temporal convolutional network as embedded in a Multitask Gaussian Process Adapter framework, making it directly applicable to irregularly spaced time series data. Our DTW-KNN is an ensemble approach that employs dynamic time warping. We then frame the timely detection of sepsis as a supervised time series classification task. For this, we derive the most recent sepsis definition in an hourly resolution to provide the first fully accessible early sepsis detection environment. Seven hours before sepsis onset, our methods MGP-TCN/DTW-KNN improve area under the precision--recall curve from 0.25 to 0.35/0.40 over the state of the art. This demonstrates that they are well-suited for detecting sepsis in the crucial earlier stages when management is most effective.