Integrating large language models into specialized domains like healthcare presents unique challenges, including domain adaptation and limited labeled data. We introduce CU-ICU, a method for customizing unsupervised instruction-finetuned language models for ICU datasets by leveraging the Text-to-Text Transfer Transformer (T5) architecture. CU-ICU employs a sparse fine-tuning approach that combines few-shot prompting with selective parameter updates, enabling efficient adaptation with minimal supervision. Our evaluation across critical ICU tasks--early sepsis detection, mortality prediction, and clinical note generation--demonstrates that CU-ICU consistently improves predictive accuracy and interpretability over standard fine-tuning methods. Notably, CU-ICU achieves up to a 15% increase in sepsis detection accuracy and a 20% enhancement in generating clinically relevant explanations while updating fewer than 1% of model parameters in its most efficient configuration. These results establish CU-ICU as a scalable, low-overhead solution for delivering accurate and interpretable clinical decision support in real-world ICU environments.

The early and accurate diagnosis of sepsis is critical for enhancing patient outcomes. This study aims to use heart rate variability (HRV) features to develop an effective predictive model for sepsis detection. Critical HRV features are identified through feature engineering methods, including statistical bootstrapping and the Boruta algorithm, after which XGBoost and Random Forest classifiers are trained with differential hyperparameter settings. In addition, ensemble models are constructed to pool the prediction probabilities of high-recall and high-precision classifiers and improve model performance. Finally, a neural network model is trained on the HRV features, achieving an F1 score of 0.805, a precision of 0.851, and a recall of 0.763. The best-performing machine learning model is compared to this neural network through an interpretability analysis, where Local Interpretable Model-agnostic Explanations are implemented to determine decision-making criterion based on numerical ranges and thresholds for specific features. This study not only highlights the efficacy of HRV in automated sepsis diagnosis but also increases the transparency of black box outputs, maximizing clinical applicability.

Sepsis, a critical condition from the body's response to infection, poses a major global health crisis affecting all age groups. Timely detection and intervention are crucial for reducing healthcare expenses and improving patient outcomes. This paper examines the limitations of traditional sepsis screening tools like Systemic Inflammatory Response Syndrome, Modified Early Warning Score, and Quick Sequential Organ Failure Assessment, highlighting the need for advanced approaches. We propose using machine learning techniques - Random Forest, Extreme Gradient Boosting, and Decision Tree models - to predict sepsis onset. Our study evaluates these models individually and in a combined meta-ensemble approach using key metrics such as Accuracy, Precision, Recall, F1 score, and Area Under the Receiver Operating Characteristic Curve. Results show that the meta-ensemble model outperforms individual models, achieving an AUC-ROC score of 0.96, indicating superior predictive accuracy for early sepsis detection. The Random Forest model also performs well with an AUC-ROC score of 0.95, while Extreme Gradient Boosting and Decision Tree models score 0.94 and 0.90, respectively.

The biomedical field is among the sectors most impacted by the increasing regulation of Artificial Intelligence (AI) and data protection legislation, given the sensitivity of patient information. However, the rise of synthetic data generation methods offers a promising opportunity for data-driven technologies. In this study, we propose a statistical approach for synthetic data generation applicable in classification problems. We assess the utility and privacy implications of synthetic data generated by Kernel Density Estimator and K-Nearest Neighbors sampling (KDE-KNN) within a real-world context, specifically focusing on its application in sepsis detection. The detection of sepsis is a critical challenge in clinical practice due to its rapid progression and potentially life-threatening consequences. Moreover, we emphasize the benefits of KDE-KNN compared to current synthetic data generation methodologies. Additionally, our study examines the effects of incorporating synthetic data into model training procedures. This investigation provides valuable insights into the effectiveness of synthetic data generation techniques in mitigating regulatory constraints within the biomedical field.

This study proposes the use of Machine Learning models to predict the early onset of sepsis using deidentified clinical data from Montefiore Medical Center in Bronx, NY, USA. A supervised learning approach was adopted, wherein an XGBoost model was trained utilizing 80\% of the train dataset, encompassing 107 features (including the original and derived features). Subsequently, the model was evaluated on the remaining 20\% of the test data. The model was validated on prospective data that was entirely unseen during the training phase. To assess the model's performance at the individual patient level and timeliness of the prediction, a normalized utility score was employed, a widely recognized scoring methodology for sepsis detection, as outlined in the PhysioNet Sepsis Challenge paper. Metrics such as F1 Score, Sensitivity, Specificity, and Flag Rate were also devised. The model achieved a normalized utility score of 0.494 on test data and 0.378 on prospective data at threshold 0.3. The F1 scores were 80.8\% and 67.1\% respectively for the test data and the prospective data for the same threshold, highlighting its potential to be integrated into clinical decision-making processes effectively. These results bear testament to the model's robust predictive capabilities and its potential to substantially impact clinical decision-making processes.

Interpreting machine learning models remains a challenge, hindering their adoption in clinical settings. This paper proposes leveraging Local Interpretable Model-Agnostic Explanations (LIME) to provide interpretable descriptions of black box classification models in high-stakes sepsis detection. By analyzing misclassified instances, significant features contributing to suboptimal performance are identified. The analysis reveals regions where the classifier performs poorly, allowing the calculation of error rates within these regions. This knowledge is crucial for cautious decision-making in sepsis detection and other critical applications. The proposed approach is demonstrated using the eICU dataset, effectively identifying and visualizing regions where the classifier underperforms. By enhancing interpretability, our method promotes the adoption of machine learning models in clinical practice, empowering informed decision-making and mitigating risks in critical scenarios.

Patients are 20% less likely to die of sepsis because a new AI system developed at Johns Hopkins University catches symptoms hours earlier than traditional methods, an extensive hospital study demonstrates. The system scours medical records and clinical notes to identify patients at risk of life-threatening complications. The work, which could significantly cut patient mortality from one of the top causes of hospital deaths worldwide, is published today in Nature Medicine and Nature Digital Medicine. "It is the first instance where AI is implemented at the bedside, used by thousands of providers, and where we're seeing lives saved," said Suchi Saria, founding research director of the Malone Center for Engineering in Healthcare at Johns Hopkins and lead author of the studies, which evaluated more than a half million patients over two years. "This is an extraordinary leap that will save thousands of sepsis patients annually. And the approach is now being applied to improve outcomes in other important problem areas beyond sepsis."

Motivation: Sepsis is a life-threatening host response to infection associated with high mortality, morbidity and health costs. Its management is highly time-sensitive since each hour of delayed treatment increases mortality due to irreversible organ damage. Meanwhile, despite decades of clinical research robust biomarkers for sepsis are missing. Therefore, detecting sepsis early by utilizing the affluence of high-resolution intensive care records has become a challenging machine learning problem. Recent advances in deep learning and data mining promise a powerful set of tools to efficiently address this task. Results: This paper proposes two approaches for the early detection of sepsis: a new deep learning model (MGP-TCN) and a data mining model (DTW-KNN). MGP-TCN employs a temporal convolutional network as embedded in a Multitask Gaussian Process Adapter framework, making it directly applicable to irregularly spaced time series data. Our DTW-KNN is an ensemble approach that employs dynamic time warping. We then frame the timely detection of sepsis as a supervised time series classification task. For this, we derive the most recent sepsis definition in an hourly resolution to provide the first fully accessible early sepsis detection environment. Seven hours before sepsis onset, our methods MGP-TCN/DTW-KNN improve area under the precision--recall curve from 0.25 to 0.35/0.40 over the state of the art. This demonstrates that they are well-suited for detecting sepsis in the crucial earlier stages when management is most effective.

We study multiple rule-based and machine learning (ML) models for sepsis detection. We report the first neural network detection and prediction results on three categories of sepsis. We have used the retrospective Medical Information Mart for Intensive Care (MIMIC)-III dataset, restricted to intensive care unit (ICU) patients. Features for prediction were created from only common vital sign measurements. We show significant improvement of AUC score using neural network based ensemble model compared to single ML and rule-based models. For the detection of sepsis, severe sepsis, and septic shock, our model achieves an AUC of 0.94, 0.91 and 0.89, respectively. Four hours before the onset, it predicts the same three categories with an AUC of 0.80, 0.81 and 0.84 respectively. Further, we ranked the features and found that using six vital signs consistently provides higher detection and prediction AUC for all the models tested. Our novel ensemble model achieves highest AUC in detecting and predicting sepsis, severe sepsis, and septic shock in the MIMIC-III ICU patients, and is amenable to deployment in hospital settings.