title: Prognostic models based on patient snapshots and time windows: Predicting disease progression to assisted ventilation in Amyotrophic Lateral Sclerosis.
abstract: Amyotrophic Lateral Sclerosis (ALS) is a devastating disease and the most common neurodegenerative disorder of young adults. ALS patients present a rapidly progressive motor weakness. This usually leads to death in a few years by respiratory failure. The correct prediction of respiratory insufficiency is thus key for patient management. In this context, we propose an innovative approach for prognostic prediction based on patient snapshots and time windows. We first cluster temporally-related tests to obtain snapshots of the patient's condition at a given time (patient snapshots). Then we use the snapshots to predict the probability of an ALS patient to require assisted ventilation after k days from the time of clinical evaluation (time window). This probability is based on the patient's current condition, evaluated using clinical features, including functional impairment assessments and a complete set of respiratory tests. The prognostic models include three temporal windows allowing to perform short, medium and long term prognosis regarding progression to assisted ventilation. Experimental results show an area under the receiver operating characteristics curve (AUC) in the test set of approximately 79% for time windows of 90, 180 and 365 days. Creating patient snapshots using hierarchical clustering with constraints outperforms the state of the art, and the proposed prognostic model becomes the first non population-based approach for prognostic prediction in ALS. The results are promising and should enhance the current clinical practice, largely supported by non-standardized tests and clinicians' experience.
authors.affiliation: INESC-ID Lisbon and Instituto Superior Técnico, Universidade de Lisboa, Portugal. Electronic address: andre.carreiro@tecnico.ulisboa.pt.
authors.forename: André V
authors.initials: AV
authors.lastname: Carreiro
authors.affiliation: INESC-ID Lisbon and Instituto Superior Técnico, Universidade de Lisboa, Portugal.
authors.forename: Pedro M T
authors.initials: PMT
authors.lastname: Amaral
authors.affiliation: Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, Universidade de Lisboa, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Pinto
authors.affiliation: INESC-ID Lisbon and Instituto Superior Técnico, Universidade de Lisboa, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Tomás
authors.affiliation: Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, Universidade de Lisboa, Portugal.
authors.forename: Mamede
authors.initials: M
authors.lastname: de Carvalho
authors.affiliation: INESC-ID Lisbon and Instituto Superior Técnico, Universidade de Lisboa, Portugal. Electronic address: sara.madeira@tecnico.ulisboa.pt.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Madeira
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology*; D018450:Disease Progression; D006801:Humans; D008962:Models, Theoretical; D011379:Prognosis; D012121:Respiration, Artificial
keywords: Amyotrophic Lateral Sclerosis; Disease progression; Patient snapshots; Prognostic model; Time windows