Representation and Reinforcement Learning for Personalized Glycemic Control in Septic Patients
This addresses the challenge of personalized glycemic control in critical care for septic patients, representing an incremental advance by applying existing methods to a new domain.
This work tackled the problem of learning personalized optimal glycemic trajectories for severely ill septic patients by using reinforcement learning with patient state encoding, resulting in a potential reduction of the estimated 90-day mortality rate by 6.3%, from 31% to 24.7%.
Glycemic control is essential for critical care. However, it is a challenging task because there has been no study on personalized optimal strategies for glycemic control. This work aims to learn personalized optimal glycemic trajectories for severely ill septic patients by learning data-driven policies to identify optimal targeted blood glucose levels as a reference for clinicians. We encoded patient states using a sparse autoencoder and adopted a reinforcement learning paradigm using policy iteration to learn the optimal policy from data. We also estimated the expected return following the policy learned from the recorded glycemic trajectories, which yielded a function indicating the relationship between real blood glucose values and 90-day mortality rates. This suggests that the learned optimal policy could reduce the patients' estimated 90-day mortality rate by 6.3%, from 31% to 24.7%. The result demonstrates that reinforcement learning with appropriate patient state encoding can potentially provide optimal glycemic trajectories and allow clinicians to design a personalized strategy for glycemic control in septic patients.