Deep Dynamic Patient Similarity Analysis: Model Development and Validation in ICU.

BACKGROUND: Personalized medicine requires the patient similarity analysis for providing specific treatments tailed for each patient. However, the patient similarity analysis in personalized clinical scenarios encounters challenges, which are twofold. First, heterogeneous and multi-type data are usually recorded to Electronic Health Records (EHRs) during the course of admissions, which makes it difficult to measure the patient similarity. Second, disease progression manifests diverse disease states at different times, which brings sequential complexity to dynamically retrieve similar patients' sequences. MATERIALS AND METHODS: To overcome the above-mentioned challenges, we propose a novel dynamic patient similarity analysis model based on deep learning. Specifically, the proposed model embeds the multi-type and heterogeneous data into hidden representations with a specially designed embedding and attention module. Thereafter, the proposed model retrieves similar patients' sequences based on these hidden representations in a dynamic manner. More importantly, we adopt two clinical tasks, i.e., diagnosis prediction and medication recommendation, to validate the effectiveness of the proposed model. It is worth noticing that the proposed model integrates a drug-drug interaction (DDI) knowledge graph in the medication recommendation task to reduce adverse reactions caused by combinational treatments, such that a more rational strategy can be realized. We evaluate our proposed model using the critical care database MIMIC-III, which includes 5,430 patients covering 14,096 clinical visits. RESULTS: The proposed model outperforms several state-of-the-art methods. For diagnosis prediction, the average PR-AUC score of the proposed model reaches 0.6200, which is significantly higher than that of the baseline models (0.2497∼0.5407). Meanwhile, for medication recommendation, the average PR-AUC of the proposed model is 0.6682 (Jaccard: 0.4070; F1: 0.5672; Recall: 0.7832) whereas the K-nearest model can only reach 0.3805 (Jaccard: 0.3911; F1: 0.5465; Recall: 0.5705). In addition, our proposed model achieves a lower DDI rate. CONCLUSION: We propose a novel dynamic patient similarity analysis model, which can be implemented into a decision support system for clinical tasks including diagnosis prediction, surgical procedure selection, medication recommendation, etc. Also, the proposed model serves as an explainable protocol in clinical practice thanks to its analogy to real clinical reasoning where a doctor diagnoses diseases and prescribes medications according to the previous cured patients empirically.