A Transformer-Based Deep Learning Approach for Fairly Predicting Post-Liver Transplant Risk Factors

Liver transplantation is a life-saving procedure for patients with end-stage liver disease. There are two main challenges in liver transplant: finding the best matching patient for a donor and ensuring transplant equity among different subpopulations. The current MELD scoring system evaluates a patient's mortality risk if not receiving an organ within 90 days. However, the donor-patient matching should also take into consideration post-transplant risk factors, such as cardiovascular disease, chronic rejection, etc., which are all common complications after transplant. Accurate prediction of these risk scores remains a significant challenge. In this study, we will use predictive models to solve the above challenge. We propose a deep learning framework model to predict multiple risk factors after a liver transplant. By formulating it as a multi-task learning problem, the proposed deep neural network was trained on this data to simultaneously predict the five post-transplant risks and achieve equally good performance by leveraging task balancing techniques. We also propose a novel fairness achieving algorithm and to ensure prediction fairness across different subpopulations. We used electronic health records of 160,360 liver transplant patients, including demographic information, clinical variables, and laboratory values, collected from the liver transplant records of the United States from 1987 to 2018. The performance of the model was evaluated using various performance metrics such as AUROC, AURPC, and accuracy. The results of our experiments demonstrate that the proposed multitask prediction model achieved high accuracy and good balance in predicting all five post-transplant risk factors, with a maximum accuracy discrepancy of only 2.7%. The fairness-achieving algorithm significantly reduced the fairness disparity compared to the baseline model.

Multi-Task Learning for Post-transplant Cause of Death Analysis: A Case Study on Liver Transplant

Organ transplant is the essential treatment method for some end-stage diseases, such as liver failure. Analyzing the post-transplant cause of death (CoD) after organ transplant provides a powerful tool for clinical decision making, including personalized treatment and organ allocation. However, traditional methods like Model for End-stage Liver Disease (MELD) score and conventional machine learning (ML) methods are limited in CoD analysis due to two major data and model-related challenges. To address this, we propose a novel framework called CoD-MTL leveraging multi-task learning to model the semantic relationships between various CoD prediction tasks jointly. Specifically, we develop a novel tree distillation strategy for multi-task learning, which combines the strength of both the tree model and multi-task learning. Experimental results are presented to show the precise and reliable CoD predictions of our framework. A case study is conducted to demonstrate the clinical importance of our method in the liver transplant.

Zero-shot Clinical Entity Recognition using ChatGPT

In this study, we investigated the potential of ChatGPT, a large language model developed by OpenAI, for the clinical named entity recognition task defined in the 2010 i2b2 challenge, in a zero-shot setting with two different prompt strategies. We compared its performance with GPT-3 in a similar zero-shot setting, as well as a fine-tuned BioClinicalBERT model using a set of synthetic clinical notes from MTSamples. Our findings revealed that ChatGPT outperformed GPT-3 in the zero-shot setting, with F1 scores of 0.418 (vs.0.250) and 0.620 (vs. 0.480) for exact- and relaxed-matching, respectively. Moreover, prompts affected ChatGPT's performance greatly, with relaxed-matching F1 scores of 0.628 vs.0.541 for two different prompt strategies. Although ChatGPT's performance was still lower than that of the supervised BioClinicalBERT model (i.e., relaxed-matching F1 scores of 0.628 vs. 0.870), our study demonstrates the great potential of ChatGPT for clinical NER tasks in a zero-shot setting, which is much more appealing as it does not require any annotation.

SPeC: A Soft Prompt-Based Calibration on Mitigating Performance Variability in Clinical Notes Summarization

Electronic health records (EHRs) store an extensive array of patient information, encompassing medical histories, diagnoses, treatments, and test outcomes. These records are crucial for enabling healthcare providers to make well-informed decisions regarding patient care. Summarizing clinical notes further assists healthcare professionals in pinpointing potential health risks and making better-informed decisions. This process contributes to reducing errors and enhancing patient outcomes by ensuring providers have access to the most pertinent and current patient data. Recent research has shown that incorporating prompts with large language models (LLMs) substantially boosts the efficacy of summarization tasks. However, we show that this approach also leads to increased output variance, resulting in notably divergent outputs even when prompts share similar meanings. To tackle this challenge, we introduce a model-agnostic Soft Prompt-Based Calibration (SPeC) pipeline that employs soft prompts to diminish variance while preserving the advantages of prompt-based summarization. Experimental findings on multiple clinical note tasks and LLMs indicate that our method not only bolsters performance but also effectively curbs variance for various LLMs, providing a more uniform and dependable solution for summarizing vital medical information.

Towards Fair Patient-Trial Matching via Patient-Criterion Level Fairness Constraint

Clinical trials are indispensable in developing new treatments, but they face obstacles in patient recruitment and retention, hindering the enrollment of necessary participants. To tackle these challenges, deep learning frameworks have been created to match patients to trials. These frameworks calculate the similarity between patients and clinical trial eligibility criteria, considering the discrepancy between inclusion and exclusion criteria. Recent studies have shown that these frameworks outperform earlier approaches. However, deep learning models may raise fairness issues in patient-trial matching when certain sensitive groups of individuals are underrepresented in clinical trials, leading to incomplete or inaccurate data and potential harm. To tackle the issue of fairness, this work proposes a fair patient-trial matching framework by generating a patient-criterion level fairness constraint. The proposed framework considers the inconsistency between the embedding of inclusion and exclusion criteria among patients of different sensitive groups. The experimental results on real-world patient-trial and patient-criterion matching tasks demonstrate that the proposed framework can successfully alleviate the predictions that tend to be biased.

LLM for Patient-Trial Matching: Privacy-Aware Data Augmentation Towards Better Performance and Generalizability

The process of matching patients with suitable clinical trials is essential for advancing medical research and providing optimal care. However, current approaches face challenges such as data standardization, ethical considerations, and a lack of interoperability between Electronic Health Records (EHRs) and clinical trial criteria. In this paper, we explore the potential of large language models (LLMs) to address these challenges by leveraging their advanced natural language generation capabilities to improve compatibility between EHRs and clinical trial descriptions. We propose an innovative privacy-aware data augmentation approach for LLM-based patient-trial matching (LLM-PTM), which balances the benefits of LLMs while ensuring the security and confidentiality of sensitive patient data. Our experiments demonstrate a 7.32% average improvement in performance using the proposed LLM-PTM method, and the generalizability to new data is improved by 12.12%. Additionally, we present case studies to further illustrate the effectiveness of our approach and provide a deeper understanding of its underlying principles.

Does Synthetic Data Generation of LLMs Help Clinical Text Mining?

Recent advancements in large language models (LLMs) have led to the development of highly potent models like OpenAI's ChatGPT. These models have exhibited exceptional performance in a variety of tasks, such as question answering, essay composition, and code generation. However, their effectiveness in the healthcare sector remains uncertain. In this study, we seek to investigate the potential of ChatGPT to aid in clinical text mining by examining its ability to extract structured information from unstructured healthcare texts, with a focus on biological named entity recognition and relation extraction. However, our preliminary results indicate that employing ChatGPT directly for these tasks resulted in poor performance and raised privacy concerns associated with uploading patients' information to the ChatGPT API. To overcome these limitations, we propose a new training paradigm that involves generating a vast quantity of high-quality synthetic data with labels utilizing ChatGPT and fine-tuning a local model for the downstream task. Our method has resulted in significant improvements in the performance of downstream tasks, improving the F1-score from 23.37% to 63.99% for the named entity recognition task and from 75.86% to 83.59% for the relation extraction task. Furthermore, generating data using ChatGPT can significantly reduce the time and effort required for data collection and labeling, as well as mitigate data privacy concerns. In summary, the proposed framework presents a promising solution to enhance the applicability of LLM models to clinical text mining.

Fairly Predicting Graft Failure in Liver Transplant for Organ Assigning

Liver transplant is an essential therapy performed for severe liver diseases. The fact of scarce liver resources makes the organ assigning crucial. Model for End-stage Liver Disease (MELD) score is a widely adopted criterion when making organ distribution decisions. However, it ignores post-transplant outcomes and organ/donor features. These limitations motivate the emergence of machine learning (ML) models. Unfortunately, ML models could be unfair and trigger bias against certain groups of people. To tackle this problem, this work proposes a fair machine learning framework targeting graft failure prediction in liver transplant. Specifically, knowledge distillation is employed to handle dense and sparse features by combining the advantages of tree models and neural networks. A two-step debiasing method is tailored for this framework to enhance fairness. Experiments are conducted to analyze unfairness issues in existing models and demonstrate the superiority of our method in both prediction and fairness performance.

Private Semi-supervised Knowledge Transfer for Deep Learning from Noisy Labels

Deep learning models trained on large-scale data have achieved encouraging performance in many real-world tasks. Meanwhile, publishing those models trained on sensitive datasets, such as medical records, could pose serious privacy concerns. To counter these issues, one of the current state-of-the-art approaches is the Private Aggregation of Teacher Ensembles, or PATE, which achieved promising results in preserving the utility of the model while providing a strong privacy guarantee. PATE combines an ensemble of "teacher models" trained on sensitive data and transfers the knowledge to a "student" model through the noisy aggregation of teachers' votes for labeling unlabeled public data which the student model will be trained on. However, the knowledge or voted labels learned by the student are noisy due to private aggregation. Learning directly from noisy labels can significantly impact the accuracy of the student model. In this paper, we propose the PATE++ mechanism, which combines the current advanced noisy label training mechanisms with the original PATE framework to enhance its accuracy. A novel structure of Generative Adversarial Nets (GANs) is developed in order to integrate them effectively. In addition, we develop a novel noisy label detection mechanism for semi-supervised model training to further improve student model performance when training with noisy labels. We evaluate our method on Fashion-MNIST and SVHN to show the improvements on the original PATE on all measures.

MULTIPAR: Supervised Irregular Tensor Factorization with Multi-task Learning

Tensor factorization has received increasing interest due to its intrinsic ability to capture latent factors in multi-dimensional data with many applications such as recommender systems and Electronic Health Records (EHR) mining. PARAFAC2 and its variants have been proposed to address irregular tensors where one of the tensor modes is not aligned, e.g., different users in recommender systems or patients in EHRs may have different length of records. PARAFAC2 has been successfully applied on EHRs for extracting meaningful medical concepts (phenotypes). Despite recent advancements, current models' predictability and interpretability are not satisfactory, which limits its utility for downstream analysis. In this paper, we propose MULTIPAR: a supervised irregular tensor factorization with multi-task learning. MULTIPAR is flexible to incorporate both static (e.g. in-hospital mortality prediction) and continuous or dynamic (e.g. the need for ventilation) tasks. By supervising the tensor factorization with downstream prediction tasks and leveraging information from multiple related predictive tasks, MULTIPAR can yield not only more meaningful phenotypes but also better predictive performance for downstream tasks. We conduct extensive experiments on two real-world temporal EHR datasets to demonstrate that MULTIPAR is scalable and achieves better tensor fit with more meaningful subgroups and stronger predictive performance compared to existing state-of-the-art methods.