Learning (Predictive) Risk Scores in the Presence of Censoring due to Interventions

Abstract

A large and diverse set of measurements are regularly collected during a patient's hospital stay to monitor their health status. Tools for integrating these measurements into severity scores, that accurately track changes in illness severity, can improve clinicians ability to provide timely interventions. Existing approaches for creating such scores either 1) rely on experts to fully specify the severity score, or 2) train a predictive score, using supervised learning, by regressing against a surrogate marker of severity such as the presence of downstream adverse events. The first approach does not extend to diseases where an accurate score cannot be elicited from experts. The second approach often produces scores that suffer from bias due to treatment-related censoring (Paxton, 2013). We propose a novel ranking based framework for disease severity score learning (DSSL). DSSL exploits the following key observation: while it is challenging for experts to quantify the disease severity at any given time, it is often easy to compare the disease severity at two different times. Extending existing ranking algorithms, DSSL learns a function that maps a vector of patient's measurements to a scalar severity score such that the resulting score is temporally smooth and consistent with the expert's ranking of pairs of disease states. We apply DSSL to the problem of learning a sepsis severity score using a large, real-world dataset. The learned scores significantly outperform state-of-the-art clinical scores in ranking patient states by severity and in early detection of future adverse events. We also show that the learned disease severity trajectories are consistent with clinical expectations of disease evolution. Further, using simulated datasets, we show that DSSL exhibits better generalization performance to changes in treatment patterns compared to the above approaches.