'I was given a choice - keep my legs or keep my life' - the sepsis patient who lived Farmer Marshall Wylie thought nothing of it when he cut his arm, sorting wood in August 2023. And he thought even less of it when he felt ill over the next 48 hours. But the following week, he said he clinically died due to sepsis, and eventually his legs had to be amputated. Farmers are at particular risk of developing sepsis due to incidents on the farm, but can also be reluctant to seek healthcare. Warning: This article contains some graphic images of hands and feet with sepsis.

Algorithm 1 Hard-gating Algorithm for In-Stage IDKCascade Input Ds: Training data containing Ns samples in stage-s Ms: Sorted list of the models trained for stage-s C: Dictionary of models' spatio-temporal costs cs: User-defined budget of spatio-temporal cost for stage-s q: Confidence function maxA: Value for the upper bound of the cutoffs to avoid over-fitting nBins: Number of bins for the grid search Output s: The optimal IDK cutoff vector for stage-s 1: procedure HARDGATING(Ds, Ms, cs, C, q, maxA, nBins) 2: s =[], ModelAssign = 1, cost = P We use the Sepsis-3 toolkit3 to obtain the suspected infection time in patients, and following the process in Seymour et al. (2016) to finally label the onset of sepsis. We result at a total number of 20,009 sepsis patients out of the 52,902 adult patients from MIMIC-III database. We exclude those patients who stay in ICUs less than 6 hours and also exclude those patients who developed sepsis within the first 6 hours after ICU admission. This reduces our cohort to a total of 34,475ICU patient, and only 2,370(6.8%) Then according to Singer et al. (2016), we identify the onset of septic shock as Algorithm 3 End-to-End Training algorithm for UnfoldML Input D: Full training data containing N instances M: Full model zoo C: Dictionary of models' spatio-temporal costs q: Confidence criterion Output: the optimal ICK1 gate parameters (or a,b): the optimal IDK gate parameters 1: procedure END-TO-ENDTRAINING (D, M) 2: Pre-allocate costs cs for each stage s. Figure 4: Transitions in model calls: both cascades always call the first model per each stage for an entrance and transition to next models (IDK) or next stage (ICK).

Abstract--Sepsis is a leading cause of mortality in intensive care units (ICUs), yet existing research often relies on outdated datasets, non-reproducible preprocessing pipelines, and limited coverage of clinical interventions. We introduce MIMIC-Sepsis, a curated cohort and benchmark framework derived from the MIMIC-IV database, designed to support reproducible modeling of sepsis trajectories. Our cohort includes 35,239 ICU patients with time-aligned clinical variables and standardized treatment data, including vasopressors, fluids, mechanical ventilation and antibiotics. We describe a transparent preprocess-ing pipeline--based on Sepsis-3 criteria, structured imputation strategies, and treatment inclusion--and release it alongside benchmark tasks focused on early mortality prediction, length-of-stay estimation, and shock onset classification. Empirical results demonstrate that incorporating treatment variables substantially improves model performance, particularly for Transformer-based architectures. MIMIC-Sepsis serves as a robust platform for evaluating predictive and sequential models in critical care research. Sepsis is a life-threatening condition caused by the body's extreme response to an infection that can lead to organ failure and even death.

Time Series Foundation Models (TSFMs) have recently garnered attention for their ability to model complex, large-scale time series data across domains such as retail, finance, and transportation. However, their application to sensitive, domain-specific fields like healthcare remains challenging, primarily due to the difficulty of fine-tuning these models for specialized, out-of-domain tasks with scarce publicly available datasets. In this work, we explore the use of Parameter-Efficient Fine-Tuning (PEFT) techniques to address these limitations, focusing on healthcare applications, particularly ICU vitals forecasting for sepsis patients. We introduce and evaluate two selective (BitFit and LayerNorm Tuning) and two additive (VeRA and FourierFT) PEFT techniques on multiple configurations of the Chronos TSFM for forecasting vital signs of sepsis patients. Our comparative analysis demonstrates that some of these PEFT methods outperform LoRA in terms of parameter efficiency and domain adaptation, establishing state-of-the-art (SOTA) results in ICU vital forecasting tasks. Interestingly, FourierFT applied to the Chronos (Tiny) variant surpasses the SOTA model while fine-tuning only 2,400 parameters compared to the 700K parameters of the benchmark.

Sepsis poses a major global health threat, accounting for millions of deaths annually and significant economic costs. Accurate predictions of mortality risk in sepsis patients facilitate the efficient allocation of medical resources, thereby enhancing patient survival and quality of life. Through precise risk assessments, healthcare facilities can effectively distribute intensive care beds, medical equipment, and staff, ensuring high-risk patients receive timely and appropriate care. Early identification and intervention significantly decrease mortality rates and improve patient outcomes. Current methods typically utilize only one type of data--either constant, temporal, or ICD codes. This study introduces the Time-Constant KAN Integrated Network(TCKIN), an innovative model that enhances the accuracy of sepsis mortality risk predictions by integrating both temporal and constant data from electronic health records and ICD codes. Validated against the MIMIC-III and MIMIC-IV datasets, TCKIN surpasses existing machine learning and deep learning methods in accuracy, sensitivity, and specificity. Notably, TCKIN achieved AUCs of 87.76% and 88.07%, demonstrating superior capability in identifying high-risk patients. Additionally, TCKIN effectively combats the prevalent issue of data imbalance in clinical settings, improving the detection of patients at elevated risk of mortality and facilitating timely interventions. These results confirm the model's effectiveness and its potential to transform patient management and treatment optimization in clinical practice. With this advanced risk assessment tool, healthcare providers can devise more tailored treatment plans, optimize resource utilization, and ultimately enhance survival rates and quality of life for sepsis patients.

Objective: Sepsis is a life-threatening condition. Sequential Organ Failure Assessment (SOFA) score is commonly used to assess organ dysfunction and predict ICU mortality, but it is taken as a static measurement and fails to capture dynamic changes. This study aims to investigate the relationship between dynamic changes in SOFA scores over the first 72 hours of ICU admission and patient outcomes. Design, setting, and participants: 3,253 patients in the Medical Information Mart for Intensive Care IV database who met the sepsis-3 criteria and were admitted from the emergency department with at least 72 hours of ICU admission and full-active resuscitation status were analysed. Group-based trajectory modelling with dynamic time warping and k-means clustering identified distinct trajectory patterns in dynamic SOFA scores. They were subsequently compared using Python. Main outcome measures: Outcomes including hospital and ICU mortality, length of stay in hospital and ICU, and readmission during hospital stay, were collected. Discharge time from ICU to wards and cut-offs at 7-day and 14-day were taken. Results: Four clusters were identified: A (consistently low SOFA scores), B (rapid increase followed by a decline in SOFA scores), C (higher baseline scores with gradual improvement), and D (persistently elevated scores). Cluster D had the longest ICU and hospital stays, highest ICU and hospital mortality. Discharge rates from ICU were similar for Clusters A and B, while Cluster C had initially comparable rates but a slower transition to ward. Conclusion: Monitoring dynamic changes in SOFA score is valuable for assessing sepsis severity and treatment responsiveness.

Sepsis and septic shock are a critical medical condition affecting millions globally, with a substantial mortality rate. This paper uses state-of-the-art deep learning (DL) architectures to introduce a multi-step forecasting system to predict vital signs indicative of septic shock progression in Intensive Care Units (ICUs). Our approach utilizes a short window of historical vital sign data to forecast future physiological conditions. We introduce a DL-based vital sign forecasting system that predicts up to 3 hours of future vital signs from 6 hours of past data. We further adopt the DILATE loss function to capture better the shape and temporal dynamics of vital signs, which are critical for clinical decision-making. We compare three DL models, N-BEATS, N-HiTS, and Temporal Fusion Transformer (TFT), using the publicly available eICU Collaborative Research Database (eICU-CRD), highlighting their forecasting capabilities in a critical care setting. We evaluate the performance of our models using mean squared error (MSE) and dynamic time warping (DTW) metrics. Our findings show that while TFT excels in capturing overall trends, N-HiTS is superior in retaining short-term fluctuations within a predefined range. This paper demonstrates the potential of deep learning in transforming the monitoring systems in ICUs, potentially leading to significant improvements in patient care and outcomes by accurately forecasting vital signs to assist healthcare providers in detecting early signs of physiological instability and anticipating septic shock.

Artificial intelligence and machine learning promise to transform healthcare across the board, but particularly through the use of precision medicine. Precision medicine is often defined differently than the common phrase "personalized medicine," which simply means tailoring treatments to the patient. Precision medicine, on the other hand, specifically applies machine learning to the genetic material of patients with less-common conditions. The AI finds patterns within material to identify common phenotypes, while pharmaceutical companies use that information to develop drugs targeted to the specific need. Palo Alto, California-based Endpoint Health is one player in this space looking to tap the potential machine learning has for precision medicine.

Guideline-based treatment for sepsis and septic shock is difficult because sepsis is a disparate range of life-threatening organ dysfunctions whose pathophysiology is not fully understood. Early intervention in sepsis is crucial for patient outcome, yet those interventions have adverse effects and are frequently overadministered. Greater personalization is necessary, as no single action is suitable for all patients. We present a novel application of reinforcement learning in which we identify optimal recommendations for sepsis treatment from data, estimate their confidence level, and identify treatment options infrequently observed in training data. Rather than a single recommendation, our method can present several treatment options. We examine learned policies and discover that reinforcement learning is biased against aggressive intervention due to the confounding relationship between mortality and level of treatment received. We mitigate this bias using subspace learning, and develop methodology that can yield more accurate learning policies across healthcare applications.