M2G-LLM: Enhancing Clinical Prediction via Multimodal Graph Reasoning and LLM Context Injection
Organizations: University of Pennsylvania, Philadelphia, PA, USA · University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Abstract
Integrating diverse data modalities --- such as clinical notes, laboratory results, and medical imaging --- is essential for advancing clinical decision-making. While Large Language Models (LLMs) have shown remarkable performance in processing unstructured clinical text, their limited capacity to incorporate non-text modalities hinders their broader utility in healthcare applications. Here, we introduce M2G-LLM (Multimodal MedGraph-LLM), a novel framework that enhances LLMs with multimodal integration and alignment via Graph Neural Networks (GNNs). Our approach models temporal relationships between patient visits, propagates information across clinically similar patients, and aligns heterogeneous data sources to construct enriched multimodal context vectors. These vectors are injected into the intermediate layers of the LLM, enabling joint reasoning over textual and non-textual modalities. We evaluate M2G-LLM on the MIMIC-IV and MIMIC-CXR datasets, demonstrating improvements in clinical prediction tasks over strong baseline models. Our results highlight the promise of combining the language understanding of LLMs with the relational reasoning capabilities of GNNs for comprehensive, multimodal healthcare analysis.
Figures & tables
| LLM-based | Lab+Vital | Code | Image | Text | Acc | F1 | AUC | AUPRC | Balanced Accuracy | |
|---|---|---|---|---|---|---|---|---|---|---|
| HAIM | ✗ | ✓ | ✓ | ✓ | ✓ | 71.24 (70.82–71.66) | 58.38 (58.11–58.65) | 68.48 (68.16–68.80) | 32.34 (31.47–33.21) | 59.90 (59.12–60.68) |
| M3Care | ✗ | ✓ | ✓ | ✓ | ✓ | 77.60 (76.75–78.45) | 55.30 (54.46–56.14) | 67.31 (66.68–67.94) | 31.42 (30.69–32.15) | 57.08 (56.28–57.88) |
| MUSE | ✗ | ✓ | ✓ | ✗ | ✓ | 77.21 (76.24–78.18) | 51.89 (50.64–53.14) | 65.27 (64.45–66.09) | 31.21 (29.74–32.68) | 53.98 (52.73–55.23) |
| mmFormer | ✗ | ✓ | ✓ | ✓ | ✓ | 76.28 (75.48–77.08) | 62.34 (61.39–63.29) | 69.27 (67.84–70.70) | 32.54 (30.83–34.25) | 62.56 (61.76–63.36) |
| HeLM | ✓ | ✓ | ✗ | ✗ | ✓ | 74.89 (73.69–76.09) | 51.12 (50.20–52.04) | 55.42 (54.58–56.26) | 29.81 (28.83–30.79) | 55.32 (54.45–56.19) |
| LLMM | ✓ | ✓ | ✗ | ✗ | ✓ | 75.35 (75.02–75.68) | 48.73 (48.14–49.32) | 54.57 (54.28–54.86) | 24.49 (23.46–25.52) | 50.10 (49.78–50.42) |
| LLM-based | Lab+Vital | Code | Image | Text | Acc | F1 | AUC | AUPRC | Balanced Accuracy | |
|---|---|---|---|---|---|---|---|---|---|---|
| HAIM | ✗ | ✓ | ✓ | ✓ | ✓ | 66.74 (66.14–67.34) | 48.54 (47.50–49.58) | 48.08 (47.40–48.76) | 13.38 (13.05–13.71) | 49.26 (48.27–50.25) |
| M3Care | ✗ | ✓ | ✓ | ✓ | ✓ | 80.57 (79.02–82.12) | 49.57 (49.15–49.99) | 51.14 (50.27–52.01) | 15.88 (15.43–16.33) | 49.83 (48.58–51.08) |
| MUSE | ✗ | ✓ | ✓ | ✗ | ✓ | 76.18 (75.71–76.65) | 49.24 (48.82–49.66) | 46.22 (45.96–46.48) | 12.45 (11.99–12.91) | 48.23 (47.64–48.82) |
| mmFormer | ✗ | ✓ | ✓ | ✓ | ✓ | 85.04 (84.40–85.68) | 46.82 (46.23–47.41) | 49.52 (48.19–50.85) | 15.65 (15.08–16.22) | 48.66 (48.10–49.22) |
| HeLM | ✓ | ✓ | ✗ | ✗ | ✓ | 71.89 (70.89–72.89) | 50.44 (49.41–51.47) | 51.94 (51.28–52.60) | 17.12 (16.48–17.76) | 50.49 (49.56–51.42) |
| LLMM | ✓ | ✓ | ✗ | ✗ | ✓ | 79.27 (78.40–80.14) | 47.69 (47.46–47.92) | 50.11 (49.81–50.41) | 15.12 (14.93–15.31) | 50.05 (49.38–50.72) |
| Output | Explanations |
|---|---|
| Positive Mortality Prediction | The patient has a history of coronary artery disease (CAD), multiple myocardial infarctions (MIs), including a recent NSTEMI, and congestive heart failure (CHF) with a severely reduced ejection fraction (EF) of 15% as noted in his most recent transthoracic echocardiogram (TTE). He is currently on a heparin bridge to Coumadin with a target INR of 2.5, as well as several cardiac medications, including a statin, an ACE-inhibitor, a beta-blocker, and a diuretic. Although his intake and output (I&O) balance is stable, his overall clinical status, including fluid and sodium restrictions, reflects the severity of his condition. |
| Negative Mortality Prediction | This patient is at a relatively low risk of mortality. She is a 45-year-old woman with a history of breast cancer, currently undergoing treatment, as well as well-managed hypertension and GERD. Although she is a candidate for a hysterectomy and oophorectomy due to a diagnosis of ovarian cancer, her overall health is stable, and there are no immediate signs of life-threatening complications. Her vital signs are stable, and her comorbidities, such as hypertension and GERD, are controlled with medication. |