Modeling the Effectiveness of Antibiotic Therapies Against Sepsis Using Continuous-time Hidden Markov Models

Patients suffering from sepsis need to be treated with an effective antibiotic therapy within the first hour after sepsis onset to decrease their risk of death. Microbiological data that provide information about the suitability of antibiotic therapies, however, is usually available only after 72 hours. Consequently, the treating physicians need to judge a therapy's effectiveness based on the patients' measured health records and their general health condition. This medical assessment is complex and requires years of experience. In our study, we investigate how statistical modeling can contribute to assessing the effectiveness of antibiotic therapies. To that purpose, we describe the effectiveness of antibiotic therapies by modeling sepsis patients' health conditions using a three-state continuous-time hidden Markov model (ctHMM). In literature, procalcitonin (PCT) and lactate have proven to be helpful for deriving the health condition in this context. The state probabilities obtained by the ctHMM are subsequently used to quantify the effectiveness of antibiotic therapies. To this end, we apply two different approaches, namely (i) averaging of the state probabilities and (ii) a logistic regression model. For (i), we calculate the average of the state probabilities for the state indicating a sepsis-free condition over an antibiotic administration period of 48 hours. For (ii), we use the information about antibiotic susceptibility testings as dependent variable in the logistic regression model; as independent variables, we calculate the difference between state probabilities at the start of antibiotic administration and 48 hours later. With this work, we are able to better understand the relationship between laboratory values, in particular PCT and lactate, and the patients' health condition. We further provide approaches for quantifying the effectiveness. Therefore, our work contributes to developing a clinical decision support system which helps physicians assess the effectiveness of antibiotic therapies in patients with sepsis. Supported by such a system, a physician is able to quickly adjust an ineffective therapy which avoids antibiotic resistances and increases a patient's chance to survive a sepsis.