Person:

Nemati, Shamim

Model identification for physiological systems is complicated by changes between operating regimes and measurement artifacts. We present a solution to these problems by assuming that a cohort of physiological time series is generated by switching among a finite collection of physiologically-constrained dynamical models and artifactual segments. We model the resulting time series using the switching linear dynamical systems (SLDS) framework, and present a novel learning algorithm for the class of SLDS, with the objective of identifying time series dynamics that are predictive of physiological regimes or outcomes of interest. We present exploratory results based on a simulation study and a physiological classification example of decoding postural changes from heart rate and blood pressure. We demonstrate a significant improvement in classification over methods based on feature learning via expectation maximization. The proposed learning algorithm is general, and can be extended to other applications involving state-space formulations.

Physiologic systems generate complex dynamics in their output signals that reflect the changing state of the underlying control systems. In this work, we used a switching vector autoregressive (switching VAR) framework to systematically learn and identify a collection of vital sign dynamics, which can possibly be recurrent within the same patient and shared across the entire cohort. We show that these dynamical behaviors can be used to characterize and elucidate the progression of patients' states of health over time. Using the mean arterial blood pressure time series of 337 ICU patients during the first 24 hours of their ICU stays, we demonstrated that the learned dynamics from as early as the first 8 hours of patients' ICU stays can achieve similar hospital mortality prediction performance as the well-known SAPS-I acuity scores, suggesting that the discovered latent dynamics structure may yield more timely insights into the progression of a patient's state of health than the traditional snapshot-based acuity scores.

Modern clinical databases include time series of vital signs, which are often recorded continuously during a hospital stay. Over several days, these recordings may yield many thousands of samples. In this work, we explore the feasibility of characterizing the “state of health” of a patient using the physiological dynamics inferred from these time series. The ultimate objective is to assist clinicians in allocating resources to high-risk patients. We hypothesize that “similar” patients exhibit similar dynamics and the properties and duration of these states are indicative of health and disease. We use Bayesian nonparametric machine learning methods to discover shared dynamics in patients' blood pressure (BP) time series. Each such “dynamic” captures a distinct pattern of evolution of BP and is possibly recurrent within the same time series and shared across multiple patients. Next, we examine the utility of this low-dimensional representation of BP time series for predicting mortality in patients. Our results are based on an intensive care unit (ICU) cohort of 480 patients (with 16% mortality) and indicate that the dynamics of time series of vital signs can be an independent useful predictor of outcome in ICU.