In the intensive care unit, the underlying causes of critical illness vary substantially across diagnoses, yet prediction models accounting for diagnostic heterogeneity have not been systematically studied. To address the gap, we evaluate transfer learning approaches for diagnosis-specific mortality prediction and apply both GLM- and XGBoost-based models to the eICU Collaborative Research Database. Our results demonstrate that transfer learning consistently outperforms models trained only on diagnosis-specific data and those using a well-known ICU severity-of-illness score, i.e., APACHE IVa, alone, while also achieving better calibration than models trained on the pooled data. Our findings also suggest that the Youden cutoff is a more appropriate decision threshold than the conventional 0.5 for binary outcomes, and that transfer learning maintains consistently high predictive performance across various cutoff criteria.

Electronic health record (EHR) data has emerged as a valuable resource for analyzing patient health status.

Accurate early prediction of in-hospital mortality in intensive care units (ICUs) is essential for timely clinical intervention and efficient resource allocation. This study develops and evaluates machine learning models that integrate both structured clinical data and unstructured textual information, specifically discharge summaries and radiology reports, from the MIMIC-IV database. We used LASSO and XGBoost for feature selection, followed by a multivariate logistic regression trained on the top features identified by both models. Incorporating textual features using TF-IDF and BERT embeddings significantly improved predictive performance. The final logistic regression model, which combined structured and textual input, achieved an AUC of 0.918, compared to 0.753 when using structured data alone, a relative improvement 22%. The analysis of the decision curve demonstrated a superior standardized net benefit in a wide range of threshold probabilities (0.2-0.8), confirming the clinical utility of the model. These results underscore the added prognostic value of unstructured clinical notes and support their integration into interpretable feature-driven risk prediction models for ICU patients.

Electronic health record (EHR) data has emerged as a valuable resource for analyzing patient health status.

Research on emergency and mass casualty incident (MCI) triage has been limited by the absence of openly usable, reproducible benchmarks. Yet these scenarios demand rapid identification of the patients most in need, where accurate deterioration prediction can guide timely interventions. While the MIMIC-IV-ED database is openly available to credentialed researchers, transforming it into a triage-focused benchmark requires extensive preprocessing, feature harmonization, and schema alignment -- barriers that restrict accessibility to only highly technical users. We address these gaps by first introducing an open, LLM-assisted emergency triage benchmark for deterioration prediction (ICU transfer, in-hospital mortality). The benchmark then defines two regimes: (i) a hospital-rich setting with vitals, labs, notes, chief complaints, and structured observations, and (ii) an MCI-like field simulation limited to vitals, observations, and notes. Large language models (LLMs) contributed directly to dataset construction by (i) harmonizing noisy fields such as AVPU and breathing devices, (ii) prioritizing clinically relevant vitals and labs, and (iii) guiding schema alignment and efficient merging of disparate tables. We further provide baseline models and SHAP-based interpretability analyses, illustrating predictive gaps between regimes and the features most critical for triage. Together, these contributions make triage prediction research more reproducible and accessible -- a step toward dataset democratization in clinical AI.

Accurate patient mortality prediction enables effective risk stratification, leading to personalized treatment plans and improved patient outcomes. However, predicting mortality in healthcare remains a significant challenge, with existing studies often focusing on specific diseases or limited predictor sets. This study evaluates machine learning models for all-cause in-hospital mortality prediction using the MIMIC-III database, employing a comprehensive feature engineering approach. Guided by clinical expertise and literature, we extracted key features such as vital signs (e.g., heart rate, blood pressure), laboratory results (e.g., creatinine, glucose), and demographic information. The Random Forest model achieved the highest performance with an AUC of 0.94, significantly outperforming other machine learning and deep learning approaches. This demonstrates Random Forest's robustness in handling high-dimensional, noisy clinical data and its potential for developing effective clinical decision support tools. Our findings highlight the importance of careful feature engineering for accurate mortality prediction. We conclude by discussing implications for clinical adoption and propose future directions, including enhancing model robustness and tailoring prediction models for specific diseases.

In-hospital mortality (IHM) prediction for ICU patients is critical for timely interventions and efficient resource allocation. While structured physiological data provides quantitative insights, clinical notes offer unstructured, context-rich narratives. This study integrates these modalities with Large Language Model (LLM)-generated expert summaries to improve IHM prediction accuracy. Using the MIMIC-III database, we analyzed time-series physiological data and clinical notes from the first 48 hours of ICU admission. Clinical notes were concatenated chronologically for each patient and transformed into expert summaries using Med42-v2 70B. A multi-representational learning framework was developed to integrate these data sources, leveraging LLMs to enhance textual data while mitigating direct reliance on LLM predictions, which can introduce challenges in uncertainty quantification and interpretability. The proposed model achieved an AUPRC of 0.6156 (+36.41%) and an AUROC of 0.8955 (+7.64%) compared to a time-series-only baseline. Expert summaries outperformed clinical notes or time-series data alone, demonstrating the value of LLM-generated knowledge. Performance gains were consistent across demographic groups, with notable improvements in underrepresented populations, underscoring the framework's equitable application potential. By integrating LLM-generated summaries with structured and unstructured data, the framework captures complementary patient information, significantly improving predictive performance. This approach showcases the potential of LLMs to augment critical care prediction models, emphasizing the need for domain-specific validation and advanced integration strategies for broader clinical adoption.

Algorithmic bias in healthcare mirrors existing data biases. However, the factors driving unfairness are not always known. Medical devices capture significant amounts of data but are prone to errors; for instance, pulse oximeters overestimate the arterial oxygen saturation of darker-skinned individuals, leading to worse outcomes. The impact of this bias in machine learning (ML) models remains unclear. This study addresses the technical challenges of quantifying the impact of medical device bias in downstream ML. Our experiments compare a "perfect world", without pulse oximetry bias, using SaO2 (blood-gas), to the "actual world", with biased measurements, using SpO2 (pulse oximetry). Under this counterfactual design, two models are trained with identical data, features, and settings, except for the method of measuring oxygen saturation: models using SaO2 are a "control" and models using SpO2 a "treatment". The blood-gas oximetry linked dataset was a suitable test-bed, containing 163,396 nearly-simultaneous SpO2 - SaO2 paired measurements, aligned with a wide array of clinical features and outcomes. We studied three classification tasks: in-hospital mortality, respiratory SOFA score in the next 24 hours, and SOFA score increase by two points. Models using SaO2 instead of SpO2 generally showed better performance. Patients with overestimation of O2 by pulse oximetry of > 3% had significant decreases in mortality prediction recall, from 0.63 to 0.59, P < 0.001. This mirrors clinical processes where biased pulse oximetry readings provide clinicians with false reassurance of patients' oxygen levels. A similar degradation happened in ML models, with pulse oximetry biases leading to more false negatives in predicting adverse outcomes.

Background: Sepsis is a severe condition responsible for many deaths worldwide. Accurate prediction of sepsis outcomes is crucial for timely and effective treatment. Although previous studies have used ML to forecast outcomes, they faced limitations in feature selection and model comprehensibility, resulting in less effective predictions. Thus, this research aims to develop an interpretable and accurate ML model to help clinical professionals predict in-hospital mortality. Methods: We analyzed ICU patient records from the MIMIC-III database based on specific criteria and extracted relevant data. Our feature selection process included a literature review, clinical input refinement, and using Random Forest to select the top 35 features. We performed data preprocessing, including cleaning, imputation, standardization, and applied SMOTE for oversampling to address imbalance, resulting in 4,683 patients, with admission counts of 17,429. We compared the performance of Random Forest, Gradient Boosting, Logistic Regression, SVM, and KNN models. Results: The Random Forest model was the most effective in predicting sepsis-related in-hospital mortality. It outperformed other models, achieving an accuracy of 0.90 and an AUROC of 0.97, significantly better than the existing literature. Our meticulous feature selection contributed to the model's precision and identified critical determinants of sepsis mortality. These results underscore the pivotal role of data-driven ML in healthcare, especially for predicting in-hospital mortality due to sepsis. Conclusion: This study represents a significant advancement in predicting in-hospital sepsis mortality, highlighting the potential of ML in healthcare. The implications are profound, offering a data-driven approach that enhances decision-making in patient care and reduces in-hospital mortality.

Electronic health record (EHR) data has emerged as a valuable resource for analyzing patient health status. However, the prevalence of missing data in EHR poses significant challenges to existing methods, leading to spurious correlations and suboptimal predictions. While various imputation techniques have been developed to address this issue, they often obsess unnecessary details and may introduce additional noise when making clinical predictions. To tackle this problem, we propose SMART, a Self-Supervised Missing-Aware RepresenTation Learning approach for patient health status prediction, which encodes missing information via elaborated attentions and learns to impute missing values through a novel self-supervised pre-training approach that reconstructs missing data representations in the latent space. By adopting missing-aware attentions and focusing on learning higher-order representations, SMART promotes better generalization and robustness to missing data.