Bridging Data Gaps of Rare Conditions in ICU: A Multi-Disease Adaptation Approach for Clinical Prediction

Artificial Intelligence has revolutionised critical care for common conditions. Yet, rare conditions in the intensive care unit (ICU), including recognised rare diseases and low-prevalence conditions in the ICU, remain underserved due to data scarcity and intra-condition heterogeneity. To bridge such gaps, we developed KnowRare, a domain adaptation-based deep learning framework for predicting clinical outcomes for rare conditions in the ICU. KnowRare mitigates data scarcity by initially learning condition-agnostic representations from diverse electronic health records through self-supervised pre-training. It addresses intra-condition heterogeneity by selectively adapting knowledge from clinically similar conditions with a developed condition knowledge graph. Evaluated on two ICU datasets across five clinical prediction tasks (90-day mortality, 30-day readmission, ICU mortality, remaining length of stay, and phenotyping), KnowRare consistently outperformed existing state-of-the-art models. Additionally, KnowRare demonstrated superior predictive performance compared to established ICU scoring systems, including APACHE IV and IV-a. Case studies further demonstrated KnowRare's flexibility in adapting its parameters to accommodate dataset-specific and task-specific characteristics, its generalisation to common conditions under limited data scenarios, and its rationality in selecting source conditions. These findings highlight KnowRare's potential as a robust and practical solution for supporting clinical decision-making and improving care for rare conditions in the ICU.

Improving Surgical Risk Prediction Through Integrating Automated Body Composition Analysis: a Retrospective Trial on Colectomy Surgery

Objective: To evaluate whether preoperative body composition metrics automatically extracted from CT scans can predict postoperative outcomes after colectomy, either alone or combined with clinical variables or existing risk predictors. Main outcomes and measures: The primary outcome was the predictive performance for 1-year all-cause mortality following colectomy. A Cox proportional hazards model with 1-year follow-up was used, and performance was evaluated using the concordance index (C-index) and Integrated Brier Score (IBS). Secondary outcomes included postoperative complications, unplanned readmission, blood transfusion, and severe infection, assessed using AUC and Brier Score from logistic regression. Odds ratios (OR) described associations between individual CT-derived body composition metrics and outcomes. Over 300 features were extracted from preoperative CTs across multiple vertebral levels, including skeletal muscle area, density, fat areas, and inter-tissue metrics. NSQIP scores were available for all surgeries after 2012.

Bridging Electronic Health Records and Clinical Texts: Contrastive Learning for Enhanced Clinical Tasks

Conventional machine learning models, particularly tree-based approaches, have demonstrated promising performance across various clinical prediction tasks using electronic health record (EHR) data. Despite their strengths, these models struggle with tasks that require deeper contextual understanding, such as predicting 30-day hospital readmission. This can be primarily due to the limited semantic information available in structured EHR data. To address this limitation, we propose a deep multimodal contrastive learning (CL) framework that aligns the latent representations of structured EHR data with unstructured discharge summary notes. It works by pulling together paired EHR and text embeddings while pushing apart unpaired ones. Fine-tuning the pretrained EHR encoder extracted from this framework significantly boosts downstream task performance, e.g., a 4.1% AUROC enhancement over XGBoost for 30-day readmission prediction. Such results demonstrate the effect of integrating domain knowledge from clinical notes into EHR-based pipelines, enabling more accurate and context-aware clinical decision support systems.

ChronoFormer: Time-Aware Transformer Architectures for Structured Clinical Event Modeling

The temporal complexity of electronic health record (EHR) data presents significant challenges for predicting clinical outcomes using machine learning. This paper proposes ChronoFormer, an innovative transformer based architecture specifically designed to encode and leverage temporal dependencies in longitudinal patient data. ChronoFormer integrates temporal embeddings, hierarchical attention mechanisms, and domain specific masking techniques. Extensive experiments conducted on three benchmark tasks mortality prediction, readmission prediction, and long term comorbidity onset demonstrate substantial improvements over current state of the art methods. Furthermore, detailed analyses of attention patterns underscore ChronoFormer's capability to capture clinically meaningful long range temporal relationships.

Inferring Outcome Means of Exponential Family Distributions Estimated by Deep Neural Networks

While deep neural networks (DNNs) are widely used for prediction, inference on DNN-estimated subject-specific means for categorical or exponential family outcomes remains underexplored. We address this by proposing a DNN estimator under generalized nonparametric regression models (GNRMs) and developing a rigorous inference framework. Unlike existing approaches that assume independence between prediction errors and inputs to establish the error bound, a condition often violated in GNRMs, we allow for dependence and our theoretical analysis demonstrates the feasibility of drawing inference under GNRMs. To implement inference, we consider an Ensemble Subsampling Method (ESM) that leverages U-statistics and the Hoeffding decomposition to construct reliable confidence intervals for DNN estimates. We show that, under GNRM settings, ESM enables model-free variance estimation and accounts for heterogeneity among individuals in the population. Through simulations under nonparametric logistic, Poisson, and binomial regression models, we demonstrate the effectiveness and efficiency of our method. We further apply the method to the electronic Intensive Care Unit (eICU) dataset, a large-scale collection of anonymized health records from ICU patients, to predict ICU readmission risk and offer patient-centric insights for clinical decision-making.

Prediction of 30-day hospital readmission with clinical notes and EHR information

High hospital readmission rates are associated with significant costs and health risks for patients. Therefore, it is critical to develop predictive models that can support clinicians to determine whether or not a patient will return to the hospital in a relatively short period of time (e.g, 30-days). Nowadays, it is possible to collect both structured (electronic health records - EHR) and unstructured information (clinical notes) about a patient hospital event, all potentially containing relevant information for a predictive model. However, their integration is challenging. In this work we explore the combination of clinical notes and EHRs to predict 30-day hospital readmissions. We address the representation of the various types of information available in the EHR data, as well as exploring LLMs to characterize the clinical notes. We collect both information sources as the nodes of a graph neural network (GNN). Our model achieves an AUROC of 0.72 and a balanced accuracy of 66.7\%, highlighting the importance of combining the multimodal information.

Limits of trust in medical AI

Artificial intelligence (AI) is expected to revolutionize the practice of medicine. Recent advancements in the field of deep learning have demonstrated success in a variety of clinical tasks: detecting diabetic retinopathy from images, predicting hospital readmissions, aiding in the discovery of new drugs, etc. AI's progress in medicine, however, has led to concerns regarding the potential effects of this technology upon relationships of trust in clinical practice. In this paper, I will argue that there is merit to these concerns, since AI systems can be relied upon, and are capable of reliability, but cannot be trusted, and are not capable of trustworthiness. Insofar as patients are required to rely upon AI systems for their medical decision-making, there is potential for this to produce a deficit of trust in relationships in clinical practice.

Machine Learning-Based Prediction of ICU Readmissions in Intracerebral Hemorrhage Patients: Insights from the MIMIC Databases

Intracerebral hemorrhage (ICH) is a life-risking condition characterized by bleeding within the brain parenchyma. ICU readmission in ICH patients is a critical outcome, reflecting both clinical severity and resource utilization. Accurate prediction of ICU readmission risk is crucial for guiding clinical decision-making and optimizing healthcare resources. This study utilized the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) databases, which contain comprehensive clinical and demographic data on ICU patients. Patients with ICH were identified from both databases. Various clinical, laboratory, and demographic features were extracted for analysis based on both overview literature and experts' opinions. Preprocessing methods like imputing and sampling were applied to improve the performance of our models. Machine learning techniques, such as Artificial Neural Network (ANN), XGBoost, and Random Forest, were employed to develop predictive models for ICU readmission risk. Model performance was evaluated using metrics such as AUROC, accuracy, sensitivity, and specificity. The developed models demonstrated robust predictive accuracy for ICU readmission in ICH patients, with key predictors including demographic information, clinical parameters, and laboratory measurements. Our study provides a predictive framework for ICU readmission risk in ICH patients, which can aid in clinical decision-making and improve resource allocation in intensive care settings.

TAMER: A Test-Time Adaptive MoE-Driven Framework for EHR Representation Learning

We propose TAMER, a Test-time Adaptive MoE-driven framework for EHR Representation learning. TAMER combines a Mixture-of-Experts (MoE) with Test-Time Adaptation (TTA) to address two critical challenges in EHR modeling: patient population heterogeneity and distribution shifts. The MoE component handles diverse patient subgroups, while TTA enables real-time adaptation to evolving health status distributions when new patient samples are introduced. Extensive experiments across four real-world EHR datasets demonstrate that TAMER consistently improves predictive performance for both mortality and readmission risk tasks when combined with diverse EHR modeling backbones. TAMER offers a promising approach for dynamic and personalized EHR-based predictions in practical clinical settings. Code is publicly available at https://github.com/yhzhu99/TAMER.

PT: A Plain Transformer is Good Hospital Readmission Predictor

Hospital readmission prediction is critical for clinical decision support, aiming to identify patients at risk of returning within 30 days post-discharge. High readmission rates often indicate inadequate treatment or post-discharge care, making effective prediction models essential for optimizing resources and improving patient outcomes. We propose PT, a Transformer-based model that integrates Electronic Health Records (EHR), medical images, and clinical notes to predict 30-day all-cause hospital readmissions. PT extracts features from raw data and uses specialized Transformer blocks tailored to the data's complexity. Enhanced with Random Forest for EHR feature selection and test-time ensemble techniques, PT achieves superior accuracy, scalability, and robustness. It performs well even when temporal information is missing. Our main contributions are: (1)Simplicity: A powerful and efficient baseline model outperforming existing ones in prediction accuracy; (2)Scalability: Flexible handling of various features from different modalities, achieving high performance with just clinical notes or EHR data; (3)Robustness: Strong predictive performance even with missing or unclear temporal data.