Early Recognition of Sepsis with Gaussian Process Temporal Convolutional Networks and Dynamic Time Warping

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 to deliver a powerful set of tools to efficiently address this task. This empirical study proposes two novel approaches for the early detection of sepsis: a deep learning model and a lazy learner based on time series distances. Our deep learning model employs a temporal convolutional network that is embedded in a Multi-task Gaussian Process Adapter framework, making it directly applicable to irregularly-spaced time series data. Our lazy learner, by contrast, is an ensemble approach that employs dynamic time warping. We 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 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.

[1]  Eamonn J. Keogh,et al.  Scaling up Dynamic Time Warping to Massive Dataset , 1999, PKDD.

[2]  Arise The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. , 2007, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[3]  P. Pronovost,et al.  A targeted real-time early warning score (TREWScore) for septic shock , 2015, Science Translational Medicine.

[4]  Jürgen Schmidhuber,et al.  Long Short-Term Memory , 1997, Neural Computation.

[5]  Jürgen Schmidhuber,et al.  Multi-column deep neural networks for image classification , 2012, 2012 IEEE Conference on Computer Vision and Pattern Recognition.

[6]  K. Wood,et al.  Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock* , 2006, Critical care medicine.

[7]  Leo A. Celi,et al.  The MIMIC Code Repository: enabling reproducibility in critical care research , 2017, J. Am. Medical Informatics Assoc..

[8]  Gaël Varoquaux,et al.  Scikit-learn: Machine Learning in Python , 2011, J. Mach. Learn. Res..

[9]  Geoffrey E. Hinton,et al.  Layer Normalization , 2016, ArXiv.

[10]  Christopher W. Barton,et al.  A computational approach to early sepsis detection , 2016, Comput. Biol. Medicine.

[11]  Katherine A. Heller,et al.  An Improved Multi-Output Gaussian Process RNN with Real-Time Validation for Early Sepsis Detection , 2017, MLHC.

[12]  Vladlen Koltun,et al.  Multi-Scale Context Aggregation by Dilated Convolutions , 2015, ICLR.

[13]  Germain Forestier,et al.  Judicious setting of Dynamic Time Warping's window width allows more accurate classification of time series , 2017, 2017 IEEE International Conference on Big Data (Big Data).

[14]  Matthew D. Stanley,et al.  Early sepsis detection in critical care patients using multiscale blood pressure and heart rate dynamics. , 2017, Journal of electrocardiology.

[15]  T. Rea,et al.  Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[16]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 , 2013, Critical care medicine.

[17]  Charu C. Aggarwal,et al.  Healthcare Data Analytics , 2015 .

[18]  Vladlen Koltun,et al.  An Empirical Evaluation of Generic Convolutional and Recurrent Networks for Sequence Modeling , 2018, ArXiv.

[19]  Benjamin M. Marlin,et al.  A scalable end-to-end Gaussian process adapter for irregularly sampled time series classification , 2016, NIPS.

[20]  Hye Jin Kam,et al.  Learning representations for the early detection of sepsis with deep neural networks , 2017, Comput. Biol. Medicine.

[21]  Carl E. Rasmussen,et al.  Gaussian processes for machine learning , 2005, Adaptive computation and machine learning.

[22]  J. Schmidhuber,et al.  The Sacred Infrastructure for Computational Research , 2017, SciPy.

[23]  M. Levy,et al.  Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour: Results From a Guideline-Based Performance Improvement Program* , 2014, Critical care medicine.

[24]  Yitong Li,et al.  Targeting EEG/LFP Synchrony with Neural Nets , 2017, NIPS.

[25]  Michael Bailey,et al.  Systemic inflammatory response syndrome criteria in defining severe sepsis. , 2015, The New England journal of medicine.

[26]  Uli K. Chettipally,et al.  Prediction of Sepsis in the Intensive Care Unit With Minimal Electronic Health Record Data: A Machine Learning Approach , 2016, JMIR medical informatics.

[27]  Katherine A. Heller,et al.  Learning to Detect Sepsis with a Multitask Gaussian Process RNN Classifier , 2017, ICML.

[28]  Luca Maria Gambardella,et al.  Proceedings of the Twenty-Second International Joint Conference on Artificial Intelligence Flexible, High Performance Convolutional Neural Networks for Image Classification , 2022 .

[29]  Uli K. Chettipally,et al.  Multicentre validation of a sepsis prediction algorithm using only vital sign data in the emergency department, general ward and ICU , 2018, BMJ Open.

[30]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.

[31]  Peter Szolovits,et al.  MIMIC-III, a freely accessible critical care database , 2016, Scientific Data.

[32]  Lukasz Kaiser,et al.  Attention is All you Need , 2017, NIPS.

[33]  Edwin V. Bonilla,et al.  Multi-task Gaussian Process Prediction , 2007, NIPS.

[34]  Tim Salimans,et al.  Weight Normalization: A Simple Reparameterization to Accelerate Training of Deep Neural Networks , 2016, NIPS.

[35]  Sergey Ioffe,et al.  Batch Normalization: Accelerating Deep Network Training by Reducing Internal Covariate Shift , 2015, ICML.

[36]  Tianqi Chen,et al.  Training Deep Nets with Sublinear Memory Cost , 2016, ArXiv.

[37]  R. Bellomo,et al.  Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. , 2014, JAMA.

[38]  R. Bellomo,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[39]  Fei-Fei Li,et al.  Visualizing and Understanding Recurrent Networks , 2015, ArXiv.

[40]  R. Hotchkiss,et al.  Sepsis and septic shock , 2016, Nature Reviews Disease Primers.

[41]  Takaya Saito,et al.  The Precision-Recall Plot Is More Informative than the ROC Plot When Evaluating Binary Classifiers on Imbalanced Datasets , 2015, PloS one.

[42]  Xiang Zhang,et al.  Text Understanding from Scratch , 2015, ArXiv.

[43]  M. Tivey,et al.  Prospective evaluation of a modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward , 2000 .

[44]  Hui Ding,et al.  Querying and mining of time series data: experimental comparison of representations and distance measures , 2008, Proc. VLDB Endow..

[45]  Yann Dauphin,et al.  Convolutional Sequence to Sequence Learning , 2017, ICML.

[46]  Gregory D. Hager,et al.  Temporal Convolutional Networks for Action Segmentation and Detection , 2016, 2017 IEEE Conference on Computer Vision and Pattern Recognition (CVPR).

[47]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[48]  Javier Del Ser,et al.  On-Line Dynamic Time Warping for Streaming Time Series , 2017, ECML/PKDD.

[49]  Yann Dauphin,et al.  Language Modeling with Gated Convolutional Networks , 2016, ICML.

[50]  Max Welling,et al.  Auto-Encoding Variational Bayes , 2013, ICLR.

[51]  Sarah J Beesley,et al.  Why we need a new definition of sepsis. , 2015, Annals of translational medicine.