Learning Normal Representations for Blood Biomarkers
学习正常表示以血清生物标志物
Aashna P. Shah, Michelle M. Li, Yash Lal, Seffi Cohen, Liat F. Antwarg, Morgan Sanchez, James A. Diao, Chirag J. Patel, Ben Y. Reis, Ran D. Balicer, Noa Dagan, Arjun K. Manrai
AI总结 该研究提出NORMA框架,通过结合患者历史和人口水平数据生成更精确的参考区间,以改善血清生物标志物的个性化解读,避免过度个性化导致的误诊风险。
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基于生物液体的生物标志物是临床诊断和管理的基础,但其解释主要依赖于固定的参考区间,这些区间忽略了稳定的个体间变异性。因此,基于群体的解释可能会掩盖个体基线的有意义偏差,从而延误疾病检测。为了解决这个问题,人们越来越多地尝试使用个体测试历史来个性化血清生物标志物的解释。然而,这些方法可能会过度拟合稀疏数据,导致假阳性率升高和不必要的随访,并可能无意中包含未被识别或亚临床疾病。在这里,我们利用近20亿个纵向实验室测量值,来自超过160万名北美洲、中东和东亚的个体,表明尽管实验室值高度个体化,但纯个性化区间经常过度拟合,将多达68%的测量值分类为异常,而没有与不良临床结果相应的关联。我们随后引入NORMA,一个基于条件变压器的框架,通过结合患者的历史和人口水平数据中的“正常”变异生成参考区间。NORMA生成的区间在预测结果方面更具精度,包括死亡率、急性肾损伤和慢性疾病。这些发现警示过度个性化在实验室医学中的风险,并证明将个体轨迹锚定到人口水平先验优于单独的方法。为了促进透明度,我们公开发布模型、代码和一个交互式用户界面,以实现可访问的个性化实验室解释。
Blood-based biomarkers underpin clinical diagnosis and management, yet their interpretation relies largely on fixed population reference intervals that ignore stable, intra-patient variability. As such, population-based interpretation can mask meaningful deviation from an individual's baseline, risking delayed disease detection. To remedy this, there have been increasing efforts to personalize blood biomarker interpretation using individual testing histories. However, these methods may overfit to sparse data, inflating false-positive rates and unnecessary follow-up, and can also unwittingly include unrecognized or subclinical disease. Here, we leverage nearly 2 billion longitudinal laboratory measurements from over 1.6 million individuals across North America, the Middle East, and East Asia, to show that while laboratory values are highly individual, purely personalized intervals routinely overfit, classifying up to 68% of measurements as abnormal, without corresponding associations with adverse clinical outcomes. We then introduce NORMA, a conditional transformer-based framework that generates reference intervals by conditioning on both a patient's history and population-level data about "normal" variation. NORMA-derived intervals achieve higher precision for predicting outcomes, including mortality, acute kidney injury, and chronic disease. These findings caution against over-personalization in laboratory medicine and demonstrate that anchoring individual trajectories to population-level priors outperforms either approach alone. To promote transparency, we publicly release the model, code, and an interactive user interface for accessible, individualized laboratory interpretation.