The Artificial Intelligence Clinician learns optimal treatment strategies for sepsis in intensive care
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Supporting information
Supporting information
Author(s)
Komorowski, matthieu
Celi, Leo Anthony
Badawi, Omar
Gordon, AC
Faisal, Aldo
Type
Journal Article
Abstract
Sepsis is the third leading cause of death worldwide and the main cause of mortality in hospitals1–3, but the best treatment strategy remains uncertain. In particular, evidence suggests that current practices in the administration of intravenous fluids and vasopressors are suboptimal and likely induce harm in a proportion of patients1,4–6. To tackle this sequential decision-making problem, we developed a reinforcement learning agent, the artificial intelligence (AI) Clinician, which learns from data to predict patient dynamics given specific treatment decisions. Our agent extracted implicit knowledge from an amount of patient data that exceeds many-fold the life-time experience of human clinicians and learned optimal treatment by having analysed myriads of (mostly sub-optimal) treatment decisions. We demonstrate that the value of the AI Clinician’s selected treatment is on average reliably higher than the human clinicians. In a large validation cohort independent from the training data, mortality was lowest in patients where clinicians’ actual doses matched the AI policy. Our model provides individualized and clinically interpretable treatment decisions for sepsis that could improve patient outcomes.
Date Issued
2018-10-22
Date Acceptance
2018-08-13
Citation
Nature Medicine, 2018, 24, pp.1716-1720
ISSN
1078-8956
Publisher
Nature Publishing Group
Start Page
1716
End Page
1720
Journal / Book Title
Nature Medicine
Volume
24
Copyright Statement
© 2018, Springer Nature Publishing AG
Sponsor
Engineering and Physical Sciences Research Council (EPSRC) & alumni
Identifier
https://www.nature.com/articles/s41591-018-0213-5
Subjects
Science & Technology
Life Sciences & Biomedicine
Biochemistry & Molecular Biology
Cell Biology
Medicine, Research & Experimental
Research & Experimental Medicine
INTERNATIONAL CONSENSUS DEFINITIONS
SEPTIC SHOCK
MORTALITY
MEDICINE
CRITERIA
THERAPY
ADULTS
Administration, Intravenous
Artificial Intelligence
Clinical Decision-Making
Cohort Studies
Critical Care
Female
Humans
Learning
Male
Sepsis
Software
Vasoconstrictor Agents
Humans
Sepsis
Vasoconstrictor Agents
Critical Care
Cohort Studies
Learning
Artificial Intelligence
Software
Female
Male
Administration, Intravenous
Clinical Decision-Making
Immunology
11 Medical and Health Sciences
Publication Status
Published
Date Publish Online
2018-10-22