Transformer-based Time-to-Event Prediction for Chronic Kidney Disease Deterioration
This work addresses time-to-event prediction for chronic kidney disease patients, offering potential improvements in clinical targeting, though it is incremental as it adapts transformers to a specific domain.
The authors tackled the problem of predicting time-to-event for chronic kidney disease deterioration using a novel transformer-based architecture called STRAFE, which outperformed other algorithms on a dataset of over 130,000 individuals and improved the positive predictive value for high-risk patients by 3-fold.
Deep-learning techniques, particularly the transformer model, have shown great potential in enhancing the prediction performance of longitudinal health records. While previous methods have mainly focused on fixed-time risk prediction, time-to-event prediction (also known as survival analysis) is often more appropriate for clinical scenarios. Here, we present a novel deep-learning architecture we named STRAFE, a generalizable survival analysis transformer-based architecture for electronic health records. The performance of STRAFE was evaluated using a real-world claim dataset of over 130,000 individuals with stage 3 chronic kidney disease (CKD) and was found to outperform other time-to-event prediction algorithms in predicting the exact time of deterioration to stage 5. Additionally, STRAFE was found to outperform binary outcome algorithms in predicting fixed-time risk, possibly due to its ability to train on censored data. We show that STRAFE predictions can improve the positive predictive value of high-risk patients by 3-fold, demonstrating possible usage to improve targeting for intervention programs. Finally, we suggest a novel visualization approach to predictions on a per-patient basis. In conclusion, STRAFE is a cutting-edge time-to-event prediction algorithm that has the potential to enhance risk predictions in large claims datasets.