A Two-Stage Time-Aware Transformer for Short-Horizon AECOPD Risk Prediction

The rapid symptom change of Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) makes it critical to have time-sensitive prediction models. However, most current machine learning models studying AECOPD use clinical and laboratory data, which will inevitably cause latency. To ensure timely detection of AECOPD and minimize latency, this paper focuses on home monitoring scenarios where only respiratory data from daily-use ventilators is available. We introduce a Time-Aware transformer-based AECOPD prediction model, which generates meaningful patient representations using the Time-Aware transformer to capture the symptoms and their temporal progression in ventilator data. Our experimental results demonstrate that our Time-Aware transformer-based approach outperforms traditional methods in multiple classification tasks, highlighting its potential to enhance AECOPD prediction accuracy.

Electronic Health Record (EHR) prediction models in the intensive care unit must learn from sparse and irregular measurements while preserving the clinical meaning of time and supporting transparent decision-making. We present INTERVenE, a family of Transformer architectures whose input is an interval-based, knowledge-based temporal abstraction (KBTA), a token stream of named clinical concepts (states, trends, events, contexts) drawn from a curated medical ontology, rather than an unnamed bin index or a raw measurement triplet. This naming layer is what we ask KBTA to do: it makes the model's per-token attributions resolve to clinical concepts by construction. INTERVenE offers two complementary variants: an auto-regressive decoder that generates future abstraction trajectories with a per-step risk readout (localizing when and after which events risk rises), and a bidirectional encoder for single-pass joint risk and time-to-event prediction. On 57,078 MIMIC-IV admissions, INTERVenE-Enc outperformed GRU-D, STraTS, and KarmaLego, reaching a support-weighted AUPRC of 0.672 ($+0.046$ over the strongest neural baseline, with non-overlapping 95% bootstrap CIs), AUROC of 0.901, and length-of-stay MAE of 44.4,h. INTERVenE-Ar complements these predictions with generated abstraction trajectories and evolving risk scores, achieving AUROC of 0.854 and AUPRC of 0.588 under the harder generative readout. An alternative-discretization ablation preserved predictive performance, supporting KBTA's role as a clinically named attribution substrate rather than a prerequisite for accuracy.

Early prediction of respiratory failure is critical for timely clinical intervention in intensive care units. Existing electronic health record (EHR)-based models can continuously monitor physiologic deterioration, but they may not fully capture pulmonary pathophysiology reflected in chest radiographs (CXRs). In this study, we ask whether CXR information improves prospective prediction of invasive mechanical ventilation beyond EHR signals alone. We develop a gated multimodal framework that integrates structured EHR time-series data with CXR foundation-model representations. The gating module adaptively controls the contribution of imaging features based on patient-specific clinical context, allowing the model to selectively rely on imaging information when it is informative. We prospectively evaluate the framework for predicting invasive mechanical ventilation within 24 hours in ICU patients and compare it with an established EHR-only model (Ventio), physician predictions obtained at matched clinical time points, and alternative multimodal variants. The gated multimodal models achieved higher discrimination than the EHR-only baseline, with AUROC values of 0.860 and 0.858 using REMEDIS and MedInsight CXR representations, respectively, compared with 0.752 for Ventio. Relative to physician predictions, the multimodal framework substantially improved sensitivity while maintaining favorable specificity. Compared with the EHR-only model, multimodal integration increased specificity and positive predictive value, suggesting that CXR information can refine risk estimation in selected patients. These findings support adaptive multimodal fusion as a practical strategy for incorporating imaging into prospective respiratory failure prediction.