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Improving patient care is an ongoing process, evolving from early evidence-based practices to modern AI-driven approaches. This thesis explores three key research directions aimed at improving clinical decisionmaking through AI. Adverse events, defined as negative and harmful outcomes that occur during medical care, present major challenges for hospitals. Most data-driven research using electronic health records relies on data from tertiary referral hospitals, but their patient population differs from those in hospitals of medium level of care. The first major contribution of this thesis is a data-driven Trigger Tool for predicting adverse events trained on data from a hospital of medium level of care. This tool uses a concise set of laboratory values measured within the first 24 hours of hospitalization. In addition to models using numerical features, we devised models using dichotomized features that indicate whether a laboratory value falls below or above a reference threshold. Our findings show that models using numerical features achieve high accuracy in predicting acute kidney injury and the COVID-19 associated adverse events in-hospital mortality and transfer to the ICU. Models using dichotomous features performonly slightly worse but offer better interpretability.
The second major contribution is the online-updateable AI model OptAB for selecting optimal antibiotics in sepsis patients. OptAB aims to minimize the sepsis-related organ failure score (SOFA-Score) while accounting for nephrotoxic and hepatotoxic side effects. OptAB relies on a hybrid neural network differential equation algorithm tailored to the special properties of patient data, including irregular measurements, missing values, and time-dependent confounding. Time-dependent confounding describes a dependence between time-varying covariates and treatment decisionsmade by physicians, often leading to biased treatment effect estimates. OptAB generates disease course forecasts for (combinations of ) the antibiotics vancomycin, ceftriaxone, and piperacillin/tazobactam and learns realistic treatment effects on the SOFA-Score and side effect indicative laboratory values. Results indicate that OptAB’s recommendations achieve faster efficacy than the administered antibiotics while reducing side effects.
The third major contribution is DoseAI, an online-updateable AI model that extends OptAB to optimize dosing regimens. DoseAI mitigates time-dependent confounding in dosage selection by minimizing the absolute spearman correlation between predicted and future treatment dosages. It forecasts disease progression under alternative dosing regimens and proposes optimal chemotherapy and radiotherapy dosing regimens for synthetic cancer patients. These regimens effectively reduce the tumor volume while adhering to varying maximum allowed weight loss constraints, used as a measure of toxicity.