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Register a new userDeep Reinforcement Learning for Sepsis Treatment
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Added by
Aniruddh Raghu
Publication date
2017
fields
Informatics Engineering
and research's language is
English
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Sepsis is a leading cause of mortality in intensive care units and costs hospitals billions annually. Treating a septic patient is highly challenging, because individual patients respond very differently to medical interventions and there is no universally agreed-upon treatment for sepsis. In this work, we propose an approach to deduce treatment policies for septic patients by using continuous state-space models and deep reinforcement learning. Our model learns clinically interpretable treatment policies, similar in important aspects to the treatment policies of physicians. The learned policies could be used to aid intensive care clinicians in medical decision making and improve the likelihood of patient survival.
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Sepsis is a dangerous condition that is a leading cause of patient mortality. Treating sepsis is highly challenging, because individual patients respond very differently to medical interventions and there is no universally agreed-upon treatment for sepsis. In this work, we explore the use of continuous state-space model-based reinforcement learning (RL) to discover high-quality treatment policies for sepsis patients. Our quantitative evaluation reveals that by blending the treatment strategy discovered with RL with what clinicians follow, we can obtain improved policies, potentially allowing for better medical treatment for sepsis.
Sepsis is a leading cause of mortality in intensive care units (ICUs) and costs hospitals billions annually. Treating a septic patient is highly challenging, because individual patients respond very differently to medical interventions and there is no universally agreed-upon treatment for sepsis. Understanding more about a patients physiological state at a given time could hold the key to effective treatment policies. In this work, we propose a new approach to deduce optimal treatment policies for septic patients by using continuous state-space models and deep reinforcement learning. Learning treatment policies over continuous spaces is important, because we retain more of the patients physiological information. Our model is able to learn clinically interpretable treatment policies, similar in important aspects to the treatment policies of physicians. Evaluating our algorithm on past ICU patient data, we find that our model could reduce patient mortality in the hospital by up to 3.6% over observed clinical policies, from a baseline mortality of 13.7%. The learned treatment policies could be used to aid intensive care clinicians in medical decision making and improve the likelihood of patient survival.
Sepsis is the leading cause of mortality in the ICU. It is challenging to manage because individual patients respond differently to treatment. Thus, tailoring treatment to the individual patient is essential for the best outcomes. In this paper, we take steps toward this goal by applying a mixture-of-experts framework to personalize sepsis treatment. The mixture model selectively alternates between neighbor-based (kernel) and deep reinforcement learning (DRL) experts depending on patients current history. On a large retrospective cohort, this mixture-based approach outperforms physician, kernel only, and DRL-only experts.
Guideline-based treatment for sepsis and septic shock is difficult because sepsis is a disparate range of life-threatening organ dysfunctions whose pathophysiology is not fully understood. Early intervention in sepsis is crucial for patient outcome, yet those interventions have adverse effects and are frequently overadministered. Greater personalization is necessary, as no single action is suitable for all patients. We present a novel application of reinforcement learning in which we identify optimal recommendations for sepsis treatment from data, estimate their confidence level, and identify treatment options infrequently observed in training data. Rather than a single recommendation, our method can present several treatment options. We examine learned policies and discover that reinforcement learning is biased against aggressive intervention due to the confounding relationship between mortality and level of treatment received. We mitigate this bias using subspace learning, and develop methodology that can yield more accurate learning policies across healthcare applications.
Deep reinforcement learning (DRL) methods such as the Deep Q-Network (DQN) have achieved state-of-the-art results in a variety of challenging, high-dimensional domains. This success is mainly attributed to the power of deep neural networks to learn rich domain representations for approximating the value function or policy. Batch reinforcement learning methods with linear representations, on the other hand, are more stable and require less hyper parameter tuning. Yet, substantial feature engineering is necessary to achieve good results. In this work we propose a hybrid approach -- the Least Squares Deep Q-Network (LS-DQN), which combines rich feature representations learned by a DRL algorithm with the stability of a linear least squares method. We do this by periodically re-training the last hidden layer of a DRL network with a batch least squares update. Key to our approach is a Bayesian regularization term for the least squares update, which prevents over-fitting to the more recent data. We tested LS-DQN on five Atari games and demonstrate significant improvement over vanilla DQN and Double-DQN. We also investigated the reasons for the superior performance of our method. Interestingly, we found that the performance improvement can be attributed to the large batch size used by the LS method when optimizing the last layer.
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