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Deep Learning for Identification of Acute Illness and Facial Cues of Illness.

ABSTRACT: Background: The inclusion of facial and bodily cues (clinical gestalt) in machine learning (ML) models improves the assessment of patients' health status, as shown in genetic syndromes and acute coronary syndrome. It is unknown if the inclusion of clinical gestalt improves ML-based classification of acutely ill patients. As in previous research in ML analysis of medical images, simulated or augmented data may be used to assess the usability of clinical gestalt. Objective: To assess whether a deep learning algorithm trained on a dataset of simulated and augmented facial photographs reflecting acutely ill patients can distinguish between healthy and LPS-infused, acutely ill individuals. Methods: Photographs from twenty-six volunteers whose facial features were manipulated to resemble a state of acute illness were used to extract features of illness and generate a synthetic dataset of acutely ill photographs, using a neural transfer convolutional neural network (NT-CNN) for data augmentation. Then, four distinct CNNs were trained on different parts of the facial photographs and concatenated into one final, stacked CNN which classified individuals as healthy or acutely ill. Finally, the stacked CNN was validated in an external dataset of volunteers injected with lipopolysaccharide (LPS). Results: In the external validation set, the four individual feature models distinguished acutely ill patients with sensitivities ranging from 10.5% (95% CI, 1.3-33.1% for the skin model) to 89.4% (66.9-98.7%, for the nose model). Specificity ranged from 42.1% (20.3-66.5%) for the nose model and 94.7% (73.9-99.9%) for skin. The stacked model combining all four facial features achieved an area under the receiver characteristic operating curve (AUROC) of 0.67 (0.62-0.71) and distinguished acutely ill patients with a sensitivity of 100% (82.35-100.00%) and specificity of 42.11% (20.25-66.50%). Conclusion: A deep learning algorithm trained on a synthetic, augmented dataset of facial photographs distinguished between healthy and simulated acutely ill individuals, demonstrating that synthetically generated data can be used to develop algorithms for health conditions in which large datasets are difficult to obtain. These results support the potential of facial feature analysis algorithms to support the diagnosis of acute illness.

SUBMITTER: Forte C

PROVIDER: S-EPMC8350122 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundHigh-resolution medical images that include facial regions can be used to recognize the subject's face when reconstructing 3-dimensional (3D)-rendered images from 2-dimensional (2D) sequential images, which might constitute a risk of infringement of personal information when sharing data. According to the Health Insurance Portability and Accountability Act (HIPAA) privacy rules, full-face photographic images and any comparable image are direct identifiers and considered as protected health information. Moreover, the General Data Protection Regulation (GDPR) categorizes facial images as biometric data and stipulates that special restrictions should be placed on the processing of biometric data.ObjectiveThis study aimed to develop software that can remove the header information from Digital Imaging and Communications in Medicine (DICOM) format files and facial features (eyes, nose, and ears) at the 2D sliced-image level to anonymize personal information in medical images.MethodsA total of 240 cranial magnetic resonance (MR) images were used to train the deep learning model (144, 48, and 48 for the training, validation, and test sets, respectively, from the Alzheimer's Disease Neuroimaging Initiative [ADNI] database). To overcome the small sample size problem, we used a data augmentation technique to create 576 images per epoch. We used attention-gated U-net for the basic structure of our deep learning model. To validate the performance of the software, we adapted an external test set comprising 100 cranial MR images from the Open Access Series of Imaging Studies (OASIS) database.ResultsThe facial features (eyes, nose, and ears) were successfully detected and anonymized in both test sets (48 from ADNI and 100 from OASIS). Each result was manually validated in both the 2D image plane and the 3D-rendered images. Furthermore, the ADNI test set was verified using Microsoft Azure's face recognition artificial intelligence service. By adding a user interface, we developed and distributed (via GitHub) software named "Deface program" for medical images as an open-source project.ConclusionsWe developed deep learning-based software for the anonymization of MR images that distorts the eyes, nose, and ears to prevent facial identification of the subject in reconstructed 3D images. It could be used to share medical big data for secondary research while making both data providers and recipients compliant with the relevant privacy regulations.

Project description:Background and objectivesSepsis-associated AKI is a heterogeneous clinical entity. We aimed to agnostically identify sepsis-associated AKI subphenotypes using deep learning on routinely collected data in electronic health records.Design, setting, participants, & measurementsWe used the Medical Information Mart for Intensive Care III database, which consists of electronic health record data from intensive care units in a tertiary care hospital in the United States. We included patients ≥18 years with sepsis who developed AKI within 48 hours of intensive care unit admission. We then used deep learning to utilize all available vital signs, laboratory measurements, and comorbidities to identify subphenotypes. Outcomes were mortality 28 days after AKI and dialysis requirement.ResultsWe identified 4001 patients with sepsis-associated AKI. We utilized 2546 combined features for K-means clustering, identifying three subphenotypes. Subphenotype 1 had 1443 patients, and subphenotype 2 had 1898 patients, whereas subphenotype 3 had 660 patients. Subphenotype 1 had the lowest proportion of liver disease and lowest Simplified Acute Physiology Score II scores compared with subphenotypes 2 and 3. The proportions of patients with CKD were similar between subphenotypes 1 and 3 (15%) but highest in subphenotype 2 (21%). Subphenotype 1 had lower median bilirubin levels, aspartate aminotransferase, and alanine aminotransferase compared with subphenotypes 2 and 3. Patients in subphenotype 1 also had lower median lactate, lactate dehydrogenase, and white blood cell count than patients in subphenotypes 2 and 3. Subphenotype 1 also had lower creatinine and BUN than subphenotypes 2 and 3. Dialysis requirement was lowest in subphenotype 1 (4% versus 7% [subphenotype 2] versus 26% [subphenotype 3]). The mortality 28 days after AKI was lowest in subphenotype 1 (23% versus 35% [subphenotype 2] versus 49% [subphenotype 3]). After adjustment, the adjusted odds ratio for mortality for subphenotype 3, with subphenotype 1 as a reference, was 1.9 (95% confidence interval, 1.5 to 2.4).ConclusionsUtilizing routinely collected laboratory variables, vital signs, and comorbidities, we were able to identify three distinct subphenotypes of sepsis-associated AKI with differing outcomes.

Project description:IntroductionDeep learning techniques are gaining momentum in medical research. Evidence shows that deep learning has advantages over humans in image identification and classification, such as facial image analysis in detecting people's medical conditions. While positive findings are available, little is known about the state-of-the-art of deep learning-based facial image analysis in the medical context. For the consideration of patients' welfare and the development of the practice, a timely understanding of the challenges and opportunities faced by research on deep-learning-based facial image analysis is needed. To address this gap, we aim to conduct a systematic review to identify the characteristics and effects of deep learning-based facial image analysis in medical research. Insights gained from this systematic review will provide a much-needed understanding of the characteristics, challenges, as well as opportunities in deep learning-based facial image analysis applied in the contexts of disease detection, diagnosis and prognosis.MethodsDatabases including PubMed, PsycINFO, CINAHL, IEEEXplore and Scopus will be searched for relevant studies published in English in September, 2021. Titles, abstracts and full-text articles will be screened to identify eligible articles. A manual search of the reference lists of the included articles will also be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework was adopted to guide the systematic review process. Two reviewers will independently examine the citations and select studies for inclusion. Discrepancies will be resolved by group discussions till a consensus is reached. Data will be extracted based on the research objective and selection criteria adopted in this study.Ethics and disseminationAs the study is a protocol for a systematic review, ethical approval is not required. The study findings will be disseminated via peer-reviewed publications and conference presentations.Prospero registration numberCRD42020196473.

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Deep Learning for Identification of Acute Illness and Facial Cues of Illness.

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