Risk stratification of cardiovascular patients using a novel classification tree induction algorithm with non-symmetric entropy measures

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2011.Cataloged from PDF version of thesis.Includes bibliographical references (p. 95-100).Risk stratification allows clinicians to choose treatments consistent with a patient's risk profile. Risk stratification models that integrate information from several risk attributes can aid clinical decision making. One of the technical challenges in developing risk stratification models from medical data is the class imbalance problem. Typically the number of patients that experience a serious medical event is a small subset of the entire population. The goal of my thesis work is to develop automated tools to build risk stratification models that can handle unbalanced datasets and improve risk stratification. We propose a novel classification tree induction algorithm that uses non-symmetric entropy measures to construct classification trees. We apply our methods to the application of identifying patients at high risk of cardiovascular mortality. We tested our approach on a set of 4200 patients who had recently suffered from a non-ST-elevation acute coronary syndrome. When compared to classification tree models generated using other measures proposed in the literature, the tree models constructed using non-symmetric entropy had higher recall and precision. Our models significantly outperformed models generated using logistic regression - a standard method of developing multivariate risk stratification models in the literature.by Anima Singh.S.M

On the intelligent management of sepsis in the intensive care unit

The management of the Intensive Care Unit (ICU) in a hospital has its own, very specific requirements that involve, amongst others, issues of risk-adjusted mortality and average length of stay; nurse turnover and communication with physicians; technical quality of care; the ability to meet patient's family needs; and avoid medical error due rapidly changing circumstances and work overload. In the end, good ICU management should lead to an improvement in patient outcomes. Decision making at the ICU environment is a real-time challenge that works according to very tight guidelines, which relate to often complex and sensitive research ethics issues. Clinicians in this context must act upon as much available information as possible, and could therefore, in general, benefit from at least partially automated computer-based decision support based on qualitative and quantitative information. Those taking executive decisions at ICUs will require methods that are not only reliable, but also, and this is a key issue, readily interpretable. Otherwise, any decision tool, regardless its sophistication and accuracy, risks being rendered useless. This thesis addresses this through the design and development of computer based decision making tools to assist clinicians at the ICU. It focuses on one of the main problems that they must face: the management of the Sepsis pathology. Sepsis is one of the main causes of death for non-coronary ICU patients. Its mortality rate can reach almost up to one out of two patients for septic shock, its most acute manifestation. It is a transversal condition affecting people of all ages. Surprisingly, its definition has only been standardized two decades ago as a systemic inflammatory response syndrome with confirmed infection. The research reported in this document deals with the problem of Sepsis data analysis in general and, more specifically, with the problem of survival prediction for patients affected with Severe Sepsis. The tools at the core of the investigated data analysis procedures stem from the fields of multivariate and algebraic statistics, algebraic geometry, machine learning and computational intelligence. Beyond data analysis itself, the current thesis makes contributions from a clinical point of view, as it provides substantial evidence to the debate about the impact of the preadmission use of statin drugs in the ICU outcome. It also sheds light into the dependence between Septic Shock and Multi Organic Dysfunction Syndrome. Moreover, it defines a latent set of Sepsis descriptors to be used as prognostic factors for the prediction of mortality and achieves an improvement on predictive capability over indicators currently in use.La gestió d'una Unitat de Cures Intensives (UCI) hospitalària presenta uns requisits força específics incloent, entre altres, la disminució de la taxa de mortalitat, la durada de l'ingrès, la rotació d'infermeres i la comunicació entre metges amb al finalitad de donar una atenció de qualitat atenent als requisits tant dels malalts com dels familiars. També és força important controlar i minimitzar els error mèdics deguts a canvis sobtats i a la presa ràpida de deicisions assistencials. Al cap i a la fi, la bona gestió de la UCI hauria de resultar en una reducció de la mortalitat i durada d'estada. La presa de decisions en un entorn de crítics suposa un repte de presa de decisions en temps real d'acord a unes guies clíniques molt restrictives i que, pel que fa a la recerca, poden resultar en problemes ètics força sensibles i complexos. Per tant, el personal sanitari que ha de prendre decisions sobre la gestió de malalts crítics no només requereix eines de suport a la decisió que siguin fiables sinó que, a més a més, han de ser interpretables. Altrament qualsevol eina de decisió que no presenti aquests trets no és considerarà d'utilitat clínica. Aquesta tesi doctoral adreça aquests requisits mitjançant el desenvolupament d'eines de suport a la decisió per als intensivistes i es focalitza en un dels principals problemes als que s'han denfrontar: el maneig del malalt sèptic. La Sèpsia és una de les principals causes de mortalitats a les UCIS no-coronàries i la seva taxa de mortalitat pot arribar fins a la meitat dels malalts amb xoc sèptic, la seva manifestació més severa. La Sèpsia és un síndrome transversal, que afecta a persones de totes les edats. Sorprenentment, la seva definició ha estat estandaritzada, fa només vint anys, com a la resposta inflamatòria sistèmica a una infecció corfimada. La recerca presentada en aquest document fa referència a l'anàlisi de dades de la Sèpsia en general i, de forma més específica, al problema de la predicció de la supervivència de malalts afectats amb Sèpsia Greu. Les eines i mètodes que formen la clau de bòveda d'aquest treball provenen de diversos camps com l'estadística multivariant i algebràica, geometria algebraica, aprenentatge automàtic i inteligència computacional. Més enllà de l'anàlisi per-se, aquesta tesi també presenta una contribució des de el punt de vista clínic atès que presenta evidència substancial en el debat sobre l'impacte de l'administració d'estatines previ a l'ingrès a la UCI en els malalts sèptics. També s'aclareix la forta dependència entre el xoc sèptic i el Síndrome de Disfunció Multiorgànica. Finalment, també es defineix un conjunt de descriptors latents de la Sèpsia com a factors de pronòstic per a la predicció de la mortalitat, que millora sobre els mètodes actualment més utilitzats en la UCI

OFSET_mine:an integrated framework for cardiovascular diseases risk prediction based on retinal vascular function

As cardiovascular disease (CVD) represents a spectrum of disorders that often manifestfor the first time through an acute life-threatening event, early identification of seemingly healthy subjects with various degrees of risk is a priority.More recently, traditional scores used for early identification of CVD risk are slowly being replaced by more sensitive biomarkers that assess individual, rather than population risks for CVD. Among these, retinal vascular function, as assessed by the retinal vessel analysis method (RVA), has been proven as an accurate reflection of subclinical CVD in groups of participants without overt disease but with certain inherited or acquired risk factors. Furthermore, in order to correctly detect individual risk at an early stage, specialized machine learning methods and featureselection techniques that can cope with the characteristics of the data need to bedevised.The main contribution of this thesis is an integrated framework, OFSET_mine, that combinesnovel machine learning methods to produce a bespoke solution for Cardiovascular Risk Prediction based on RVA data that is also applicable to other medical datasets with similar characteristics. The three identified essential characteristics are 1) imbalanced dataset,2) high dimensionality and 3) overlapping feature ranges with the possibility of acquiring new samples. The thesis proposes FiltADASYN as an oversampling method that deals with imbalance, DD_Rank as a feature selection method that handles high dimensionality, and GCO_mine as a method for individual-based classification, all three integrated within the OFSET_mine framework.The new oversampling method FiltADASYN extends Adaptive Synthetic Oversampling(ADASYN) with an additional step to filter the generated samples and improve the reliability of the resultant sample set. The feature selection method DD_Rank is based on Restricted Boltzmann Machine (RBM) and ranks features according to their stability and discrimination power. GCO_mine is a lazy learning method based on Graph Cut Optimization (GCO), which considers both the local arrangements and the global structure of the data.OFSET_mine compares favourably to well established composite techniques. Itex hibits high classification performance when applied to a wide range of benchmark medical datasets with variable sample size, dimensionality and imbalance ratios.When applying OFSET _mine on our RVA data, an accuracy of 99.52% is achieved. In addition, using OFSET, the hybrid solution of FiltADASYN and DD_Rank, with Random Forest on our RVA data produces risk group classifications with accuracy 99.68%. This not only reflects the success of the framework but also establishes RVAas a valuable cardiovascular risk predicto

A novel framework for predicting patients at risk of readmission

Uncertainty in decision-making for patients’ risk of re-admission arises due to non-uniform data and lack of knowledge in health system variables. The knowledge of the impact of risk factors will provide clinicians better decision-making and in reducing the number of patients admitted to the hospital. Traditional approaches are not capable to account for the uncertain nature of risk of hospital re-admissions. More problems arise due to large amount of uncertain information. Patients can be at high, medium or low risk of re-admission, and these strata have ill-defined boundaries. We believe that our model that adapts fuzzy regression method will start a novel approach to handle uncertain data, uncertain relationships between health system variables and the risk of re-admission. Because of nature of ill-defined boundaries of risk bands, this approach does allow the clinicians to target individuals at boundaries. Targeting individuals at boundaries and providing them proper care may provide some ability to move patients from high risk to low risk band. In developing this algorithm, we aimed to help potential users to assess the patients for various risk score thresholds and avoid readmission of high risk patients with proper interventions. A model for predicting patients at high risk of re-admission will enable interventions to be targeted before costs have been incurred and health status have deteriorated. A risk score cut off level would flag patients and result in net savings where intervention costs are much higher per patient. Preventing hospital re-admissions is important for patients, and our algorithm may also impact hospital income

Automatic risk evaluation in elderly patients based on Autonomic Nervous System assessment

Dysfunction of Autonomic Nervous System (ANS) is a typical feature of chronic heart failure and other cardiovascular disease. As a simple non-invasive technology, heart rate variability (HRV) analysis provides reliable information on autonomic modulation of heart rate. The aim of this thesis was to research and develop automatic methods based on ANS assessment for evaluation of risk in cardiac patients. Several features selection and machine learning algorithms have been combined to achieve the goals. Automatic assessment of disease severity in Congestive Heart Failure (CHF) patients: a completely automatic method, based on long-term HRV was proposed in order to automatically assess the severity of CHF, achieving a sensitivity rate of 93% and a specificity rate of 64% in discriminating severe versus mild patients. Automatic identification of hypertensive patients at high risk of vascular events: a completely automatic system was proposed in order to identify hypertensive patients at higher risk to develop vascular events in the 12 months following the electrocardiographic recordings, achieving a sensitivity rate of 71% and a specificity rate of 86% in identifying high-risk subjects among hypertensive patients. Automatic identification of hypertensive patients with history of fall: it was explored whether an automatic identification of fallers among hypertensive patients based on HRV was feasible. The results obtained in this thesis could have implications both in clinical practice and in clinical research. The system has been designed and developed in order to be clinically feasible. Moreover, since 5-minute ECG recording is inexpensive, easy to assess, and non-invasive, future research will focus on the clinical applicability of the system as a screening tool in non-specialized ambulatories, in order to identify high-risk patients to be shortlisted for more complex investigations

Machine Learning Methods in Real-World Studies of Cardiovascular Disease

Objective: Cardiovascular disease (CVD) is one of the leading causes of death worldwide, and answers are urgently needed regarding many aspects, particularly risk identification and prognosis prediction. Real-world studies with large numbers of observations provide an important basis for CVD research but are constrained by high dimensionality, and missing or unstructured data. Machine learning (ML) methods, including a variety of supervised and unsupervised algorithms, are useful for data governance, and are effective for high dimensional data analysis and imputation in real-world studies. This article reviews the theory, strengths and limitations, and applications of several commonly used ML methods in the CVD field, to provide a reference for further application. Methods: This article introduces the origin, purpose, theory, advantages and limitations, and applications of multiple commonly used ML algorithms, including hierarchical and k-means clustering, principal component analysis, random forest, support vector machine, and neural networks. An example uses a random forest on the Systolic Blood Pressure Intervention Trial (SPRINT) data to demonstrate the process and main results of ML application in CVD. Conclusion: ML methods are effective tools for producing real-world evidence to support clinical decisions and meet clinical needs. This review explains the principles of multiple ML methods in plain language, to provide a reference for further application. Future research is warranted to develop accurate ensemble learning methods for wide application in the medical field

Integration of multi-scale protein interactions for biomedical data analysis

With the advancement of modern technologies, we observe an increasing accumulation of biomedical data about diseases. There is a need for computational methods to sift through and extract knowledge from the diverse data available in order to improve our mechanistic understanding of diseases and improve patient care. Biomedical data come in various forms as exemplified by the various omics data. Existing studies have shown that each form of omics data gives only partial information on cells state and motivated jointly mining multi-omics, multi-modal data to extract integrated system knowledge. The interactome is of particular importance as it enables the modelling of dependencies arising from molecular interactions. This Thesis takes a special interest in the multi-scale protein interactome and its integration with computational models to extract relevant information from biomedical data. We define multi-scale interactions at different omics scale that involve proteins: pairwise protein-protein interactions, multi-protein complexes, and biological pathways. Using hypergraph representations, we motivate considering higher-order protein interactions, highlighting the complementary biological information contained in the multi-scale interactome. Based on those results, we further investigate how those multi-scale protein interactions can be used as either prior knowledge, or auxiliary data to develop machine learning algorithms. First, we design a neural network using the multi-scale organization of proteins in a cell into biological pathways as prior knowledge and train it to predict a patient's diagnosis based on transcriptomics data. From the trained models, we develop a strategy to extract biomedical knowledge pertaining to the diseases investigated. Second, we propose a general framework based on Non-negative Matrix Factorization to integrate the multi-scale protein interactome with multi-omics data. We show that our approach outperforms the existing methods, provide biomedical insights and relevant hypotheses for specific cancer types

Intelligent Biosignal Processing in Wearable and Implantable Sensors

This reprint provides a collection of papers illustrating the state-of-the-art of smart processing of data coming from wearable, implantable or portable sensors. Each paper presents the design, databases used, methodological background, obtained results, and their interpretation for biomedical applications. Revealing examples are brain–machine interfaces for medical rehabilitation, the evaluation of sympathetic nerve activity, a novel automated diagnostic tool based on ECG data to diagnose COVID-19, machine learning-based hypertension risk assessment by means of photoplethysmography and electrocardiography signals, Parkinsonian gait assessment using machine learning tools, thorough analysis of compressive sensing of ECG signals, development of a nanotechnology application for decoding vagus-nerve activity, detection of liver dysfunction using a wearable electronic nose system, prosthetic hand control using surface electromyography, epileptic seizure detection using a CNN, and premature ventricular contraction detection using deep metric learning. Thus, this reprint presents significant clinical applications as well as valuable new research issues, providing current illustrations of this new field of research by addressing the promises, challenges, and hurdles associated with the synergy of biosignal processing and AI through 16 different pertinent studies. Covering a wide range of research and application areas, this book is an excellent resource for researchers, physicians, academics, and PhD or master students working on (bio)signal and image processing, AI, biomaterials, biomechanics, and biotechnology with applications in medicine