在死亡率预测中分析各种模式的信息差异
Chanhwi Kim1,2,3, WonJin Yoon2,3, Hoonick Lee1
1Dept. of Computer Science and Engineering, Korea University, Seoul, 02841, Republic of Korea.
medRxiv : the preprint server for health sciences
|November 24, 2025
概括
将原始胸部X射线 (CXR) 与电子健康记录相结合,与仅使用放射学报告相比,在重症监护室 (ICU) 患者的30天死亡率的预测显著改善. CXR提供比文本摘要更丰富的预后数据.
科学领域:
- 人工智能在医学中的应用
- 临床信息学 临床信息学
- 医学成像分析 医学成像分析
背景情况:
- 深度学习使得使用电子健康记录 (EHR) 能够整合各种数据进行临床预测.
- 胸部放射 (CXR) 提供视觉数据,对于预测重症监护室 (ICU) 患者的预后至关重要.
- 原始CXRs与放射学报告用于预测的比较价值尚未得到充分探索.
研究的目的:
- 为了比较原始CXR与放射学报告对ICU患者30天出院后死亡率的预测性能.
- 评估不同的CXR表示如何增加患者出院笔记以预测死亡率.
- 确定最有信息的数据模式,以增强临床预测模型.
主要方法:
- 使用视觉语言模型 (VLM) 结合患者出院笔记.
- 用原始CXRs增强的比较模型与放射学报告相比,仅对出院笔记的基线进行比较.
- 分析了MIMIC-IV数据集的一个子集 (n=1,360) 用于30天死亡率预测.
主要成果:
- 增加原始CXR的放电笔记产生了最高的预测性能 (AUROC = 0.843).
- 使用CXR增强模型的表现优于仅使用退学笔记模型 (AUROC = 0.816) 和使用放射学报告增强模型 (AUROC = 0.804).
- 发现放射学报告遗漏了CXR中存在的临床相关发现,表明CXR含有更丰富的预后信息.
结论:
- 原始CXRs在增强EHR数据时,与放射学报告相比,在死亡风险预测方面提供了更好的预后信号.
- 选择正确的数据模式对于开发有效的临床AI系统至关重要.
- 像放射学报告这样的文本摘要可能无法捕获原始医疗图像中存在的基本预测信息.
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