Clinical Risk Prediction

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21 papers in the last four weeks, up 600% on the four weeks before. 0.2% of all new papers.

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Latest papers 148

Oct 6, 2026cs.LG

SepsisLens: Structure-Preserving Sequence Modelling for Decomposable Early Sepsis Warning

Early sepsis warning from ICU records can be cast as a structure-preserving prediction problem. A model needs to detect deterioration from irregular measurements while keeping each alert connected to the physiological signals that support it. Many temporal models fuse clinical variables into a patient-level representation, supporting scalar risk prediction but weakening the structure needed for clinical decomposition. We present SepsisLens, which preserves variable-indexed temporal states until risk composition. Observation-aware representations encode each variable's dynamics and measurement history, while a shared temporal encoder models each trajectory without collapsing the variable axis. The StructuredRiskHead composes multi-horizon risk from explicit variable-level and organ-level components. We evaluate SepsisLens on three public ICU cohorts and one private-hospital cohort under a common pre-onset protocol. SepsisLens achieves strong discrimination on all four cohorts and lower alert burden at matched event recall on MIMIC-IV. Structural ablations support the design, while input-side masking shows that the ranked components reflect variables with greater influence on prediction.

Yikun Ou, Wei Li

School of Computer Science, University of Sydney Sydney, Australia

Interpretable ML Clinical Prediction Longitudinal EHR Modeling Sequence Modeling Clinical Risk Prediction

Oct 6, 2026cs.LG

Cite What You Explore: Budget-Aware LLM Reasoning over Medical KGs with Verifiable Evidence

Post-discharge risk prediction from electronic health records (EHRs) is difficult because many dependencies that link discharge-time observations to downstream complications, such as comorbidity cascades and drug-disease interactions, are absent from the record. External medical knowledge graphs (KGs) can supply these missing dependencies, but tracing them demands three properties: KG exploration must remain cost-bounded, retrieved evidence must be differentiated by source quality, and the resulting rationale must be citable for retrospective review. Large language models (LLMs) can plan and verify over structured evidence, making them natural candidates for KG reasoning, but existing LLM-based methods do not satisfy these three properties jointly. In this paper, we propose BAR, a Budget-Aware LLM Reasoning framework over medical KGs with three contributions. First, BAR refines the raw KG into disease-specific evidence graphs whose edges carry support scores and provenance records, turning the KG into a quality-annotated reasoning space rather than a static feature source. Second, an LLM then reasons over this graph through a plan-navigate-verify loop that decomposes the question into steps, retrieves evidence under a patient-specific budget, and revises when verification fails. Third, a reasoning policy is trained with a reward that compares predictions with and without acquired evidence, combined with acquisition cost and citation-integrity terms. Across 8 diseases and 3 prediction horizons on MIMIC-III and MIMIC-IV, BAR improves AUPRC by 3.4 points over the strongest baseline, raises citation precision from 59.8% to 77.9%, and consumes only 62-65% of the budget cap.

Chen Chen, Dongjie Wang, Mei Liu +1

Electrical Engineering and Computer Science, University of Kansas, USA · Health Outcomes and Biomedical Informatics, University of Florida, USA

LLM Reasoning with Graphs Evidence-Grounded Reasoning Graph Reasoning Clinical Risk Prediction Biomedical KGs

Oct 5, 2026stat.AP

DeepAJM: Deep Association Joint Model for Irregularly Sampled data

Joint Models simultaneously model longitudinal and survival outcomes, leveraging patterns in patients' longitudinal trajectory to improve the prediction of survival outcomes. The classical parametric joint models, however, rely on fixed parametric assumptions, making them susceptible to bias under model misspecification and smaller sample sizes. We propose a deep joint model, DeepAJM, that does not require any parametric assumptions, while retaining a partially interpretable, per-longitudinal-outcome association structure. The joint model uses an encoder-decoder (sequence-to-sequence) architecture to learn the latent structure in patients' time-varying covariate trajectories. The model links the longitudinal processes to the survival processes through a learned interpretable association structure, in which each longitudinal output from the decoder gets remodulated by baseline covariates before it contributes to the risk scores from the survival head of the architecture. The model was evaluated on three datasets ( a cardiovascular-disease EHR cohort, a primary biliary cirrhosis (PBC2) dataset, and a simulated dataset) against a classical parametric joint model, TransformerJM, DA-LSTM and a Cox-based survival-only model. All models were assessed using C-index, integrated brier score (IBS), time-dependent AUROC, and time-dependent AUPRC. Our model achieved the best discrimination in terms of the C-index, time-dependent AUROC, and AUPRC across all datasets.

Barsha Halder, Jeffrey A. Thompson

Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA

Irregular Time-Series Modeling Survival Analysis Clinical Risk Prediction

Oct 5, 2026stat.ML

Latent Similarity Gaussian Processes: A Theory-Grounded Approach to Personalized Suicide-Risk Forecasting for Clinical Decision-Support

Forecasting suicide risk is difficult due to the high heterogeneity of patients and the low base rate of suicide-related events (SREs). We present Latent Similarity Gaussian Processes (LSGPs), which embed patients in a continuous latent space to jointly model similarity and forecast risk. By selectively drawing information from latent peers, LSGPs better capture individualized risk trajectories, generalizing nomothetic (pooled), idiographic (per-patient), and hierarchical frameworks. Our contributions are: (1) an identifiable two-channel Similarity Kernel; (2) proof that the standard model-fitting algorithm, mean-field variational inference, collapses LSGPs to nomothetic models, along with a fix; and (3) empirical results on intensive longitudinal suicide data showing LSGPs outperform nomothetic, idiographic, and hierarchical models for next-week risk forecasting, with the largest gains in forecasting first-occurrence SREs.

Yaniv Yacoby, Weiwei Pan, Hope Neveux +4

Wellesley College · Harvard University · Harvard University Harvard Medical School Massachusetts General Hospital

Latent Variable Models Suicide Risk Modeling Variational Inference Clinical Risk Prediction Gaussian Process Regression

Oct 4, 2026cs.AI

LifeLong Digital Twin: A Unified Modeling Paradigm and Agent Harness for Event-Driven Lifelong Health State Trajectories

Human health is a continuous, dynamic trajectory shaped by the cumulative interplay of biological processes, clinical events, behaviors and environmental exposures across the life course. Unifying the full breadth of lifelong health information, including longitudinal records, genetic variation, molecular profiles and environmental histories, is essential for whole-person modeling and remains a major challenge. We introduce LifeLong Digital Twin, a unified, event-driven modeling paradigm that organizes Life Events into daily Health States and accumulates them into Lifelong Health Context. An accompanying Agent Harness incorporates multimodal evidence beyond the language model's textual context. We evaluate four language models across 25 disease endpoints on three tasks: Disease Trajectory Forecasting, Disease Risk Ranking and Multi-horizon Disease Prediction. The approach yields marked gains over the reference condition: model-averaged F1 increases by 22.0% for disease identification in trajectory forecasting and 18.3% for five-year disease outcomes; thyroid-disease F1 reaches 0.669. The framework provides a foundation for whole-person digital twins and research on personalized lifelong disease prevention.

Jin Jiang, Sean Yates, Jasper Chong +4

Peking University · VITA-Med Group

Clinical Prediction Digital Twins Longitudinal EHR Modeling Clinical Risk Prediction

Oct 1, 2026cs.LG

Fixing a Model That Learned Worse Cancer Means Lower Risk: Monotonic Constraints in Bladder Cancer Recurrence Prediction

Background and Objective: Clinicians expect recurrence risk to climb with cancer severity. In a UK multicentre trial, an unconstrained XGBoost model learnt that higher tumour stage and carcinoma in situ predicted lower recurrence risk, and discrimination, calibration, and SHAP were all blind to it. We developed a counterfactual testing framework to detect this inversion and a monotonic-constraint framework to remove it without hurting performance. Methods: BOXIT enrolled 472 patients with protocol-mandated cystoscopy across 51 UK sites (2007-2012); 435 had at least two years' follow-up (153 recurrences, 35.2%). We developed a counterfactual direction test and a monotonic-constraint correction, with constraint directions drawn from the EORTC and EAU risk systems, and evaluated both against unconstrained XGBoost and logistic regression on 18 predictors (seven directed) over 50 cross-validation folds. The test worsened each patient on one directed feature at a time to check whether risk fell; SHAP direction and calibration were also assessed. Key Findings and Limitations: Tumour stage and carcinoma in situ were associated with lower recurrence, opposite to medical intuition; the unconstrained model reversed carcinoma in situ counterfactuals in 90.2% of cases and stage in 74.3%. Discrimination (

Δ

AUC 0.005, p=0.47), calibration, and SHAP magnitude were all blind to the inversion. Monotonic constraints eliminated every violation at no cost to discrimination (0.723 vs 0.718) and outperformed EORTC (p=8.9e-16). Limitations: single trial, internal-external validation only. Conclusions and Clinical Implications: A model that had learned this inversion passed every conventional check. A counterfactual direction test, run as a single refit with pre-specified monotonic constraints, catches this failure at no cost to performance and should be routine before clinical deployment.

Saram Abbas, David Thomas, Naeem Soomro +3

School of Engineering, Newcastle University, Newcastle upon Tyne, UK · Electronics and Computer Science, University of Southampton, Southampton, UK · Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK +1

Counterfactual Evaluation Gradient-Boosted Decision Trees Clinical Outcome Prediction Constrained Optimization Clinical Risk Prediction

Sep 30, 2026cs.CL

Explainable Suicide Risk Assessment on Social Media with Multi-Task QLoRA

Explainable suicide-risk assessment requires models not only to estimate risk severity, but also to identify supporting language and the risk and protective factors expressed in a post. We present our system for the IEEE BigData 2026 Cup on Explainable Suicide Risk Assessment on Social Media, which addresses three tasks: risk-level classification, evidence phrase extraction, and multi-label factor identification. Our approach adapts Qwen2.5-Instruct models using quantized low-rank adaptation (QLoRA) and an answer-masked causal language-model objective. We jointly train across all three tasks for risk classification, jointly train on Tasks~~1a and 1b for evidence extraction, and adapt Task~~2 separately for factor identification. We also tailor aggregation to each output: we average risk-level probabilities from the 32B and 72B models, combine evidence phrases through cross-fold consensus, and calibrate factor-specific decisions through rate matching based on out-of-fold operating points. On the official leaderboard, the final system achieved a composite score of 0.7738, with 0.8089 on Task~~1 and 0.6919 on Task~~2. Across the evaluated configurations, three-task training performed best for Task~~1a, joint training on Tasks~~1a and 1b performed best for Task~~1b, and task-specific training performed best for Task~~2. Probability averaging further improved Task~1a when component models had complementary errors. These findings highlight the value of tailoring both training objectives and aggregation strategies to the output structure of each task within a unified language-model framework.

Xuan Zhong Feng, Geoffrey Martin, Hexin Dong +1

Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA · Systems Engineering, Cornell University, New York, NY, USA

Social Media Analysis Multi-Task Learning Suicide Risk Modeling Clinical Risk Prediction

Sep 30, 2026cs.CL

OverdoseMoE: A Multi-Expert Framework for Opioid Overdose Risk Prediction

Opioid overdose remains a major clinical and public health burden, highlighting the need for scalable approaches to identify patients at high risk. Here, we investigate diagnosis-specific adaptation for 180-day opioid overdose risk prediction from patients' preceding one-year longitudinal ICD histories. We develop OODMAMBA and OODQWEN through continued pretraining on longitudinal diagnostic sequences followed by task-specific fine-tuning. Building on the stronger Qwen-based predictors, we further propose OVERDOSEMOE, a multi-expert framework that integrates models of different scales using complementary expert-weighting strategies. Diagnosis-specific adaptation consistently improved predictive performance over general-purpose language-model baselines, with OODQWEN achieving an AUPRC of 24.47 and an AUROC of 68.56. OVERDOSEMOE further improved discrimination and precision, achieving an AUPRC of 25.17 and an AUROC of 69.49 while outperforming the strongest single-model baselines. Among patients ranked in the top 5% of predicted risk, OVERDOSEMOE identified substantially enriched overdose risk, achieving a PPV of 25.38% while retaining meaningful recall. Evaluation on an independent MIMIC-IV cohort further demonstrated cross-cohort robustness, with complementary weighting strategies showing advantages across different performance measures. These findings demonstrate that diagnosis-specific language-model adaptation combined with multi-expert integration can improve opioid overdose risk stratification and support more robust prediction across heterogeneous electronic health record populations.

Mingchen Li, Rohan Pandey, Junhui Qian +3

Manning College of Information and Computer Sciences, UMass Amherst, Amherst, MA, USA · Center for Healthcare Organization and Implementation Research, VA Bedford Health Care, Bedford, MA, USA · Miner School of Computer and Information Sciences, UMass Lowell, Lowell, MA, USA

Mixture of Experts Longitudinal EHR Modeling Medical LLMs Clinical Risk Prediction

Sep 30, 2026cs.CV

From Image Interpretation to Clinical Reasoning: Upstream Physician-Context-Aware Multimodal Learning with Causal Reinforcement Learning

Major adverse cardiovascular events (MACE) remain the leading cause of mortality worldwide. Opportunistic screening using routinely acquired clinical data offers a scalable approach for identifying high-risk individuals before acute events occur. Although chest X-rays (CXRs) capture latent cardiovascular biomarkers and clinical histories provide complementary patient context, existing medical vision-language models are primarily optimized for radiology interpretation rather than prognostic reasoning. We propose a causal reinforcement learning framework for multimodal clinical reasoning that integrates CXRs and physician-authored clinical histories for opportunistic MACE prediction. The framework introduces (1) a role-decoupled dual-LLM architecture that separates reasoning from risk prediction, (2) a dual-action causal reinforcement learning policy for evidence selection and reasoning optimization, and (3) causal token pruning to learn compact multimodal representations. Evaluated on an internal cohort, an emergency department cohort, and the external MIMIC dataset, the proposed framework consistently outperformed unimodal baselines and state-of-the-art medical vision-language models, achieving AUROCs of 0.720, 0.760, and 0.845, respectively. It also substantially improved reasoning quality, achieving higher GREEN scores and higher expert preference while maintaining robust predictive performance across diverse patient populations.

Jialu Pi, Yanan Ma, Weijie Chen +8

Dept. of Radiology, Mayo Clinic, Phoenix, AZ, USA · School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA · Dept. of Radiology, Mayo Clinic, Phoenix, USA +2

Clinical Outcome Prediction Multimodal Reasoning Clinical Reasoning Causal RL Clinical Risk Prediction

Sep 28, 2026cs.LG

Disentangling Lung-Cancer CT/LDCT AI: A Systematic Evidence Map of Clinical Tasks, Evidence Chains, and Translational Gaps

Artificial-intelligence studies using computed tomography (CT) for lung cancer are often broadly labelled "prediction" despite addressing clinically distinct tasks. We systematically mapped CT/low-dose CT (LDCT)-centered lung-cancer AI using five-database retrieval, full-text eligibility assessment, role-aware modality/omics extraction, clinical-task classification, and a Multi-Tier Evidence Graph (MTEG). The final corpus comprised 293 studies (2016-2026): 230 Detection, 8 future Risk-prediction, and 55 Other studies. Clinical variables (96.2%), 3D CT/LDCT (73.0%), and radiomics (63.5%) predominated, whereas external validation (29.0%), calibration (20.5%), decision-curve analysis (13.0%), longitudinal CT (17.7%), and saliency/attribution XAI (21.5%) were less frequent. The MTEG comprised 377 nodes and 3,444 edges; only 31 studies (10.6%) completed the six-tier substantive evidence chain, with greatest attrition at reasoning/explanation. Overall, the literature is detection-dominated, genuine future risk prediction remains uncommon, and complete translational evidence chains are rare.

Surajit Das

Medical Image Analysis Computed Tomography Clinical Risk Prediction

Sep 28, 2026cs.CL

Unknown is not normal: separating language-model extraction from rule-based decision logic for clinical risk scores

Large language models (LLMs) are increasingly used to compute clinical risk scores from free-text notes. Notes are often incomplete, and treating undocumented findings as normal can silently misclassify patients. We test whether separating three-state extraction (present, absent or unknown, by an LLM) from decision logic (deterministic code computing score bounds over unknown inputs) lets a system ask only questions that can change the decision. On 1,200 synthetic emergency cases across six calculators (HEART, CURB-65, qSOFA, PERC, Wells, Cockcroft-Gault), with a simulated clinician answering questions, we compared this bounds policy with asking for every missing input, a missing-equals-normal schema, and an end-to-end LLM agent (Claude Opus 5.5). With Claude Haiku 4.5 as extractor, the bounds policy matched ask-all accuracy (99.4% vs 99.4%) with half the questions (0.92 vs 1.78 per case) and no irrelevant ones. Treating missing as normal dropped accuracy to 91.2% and under-triaged 8.5% of patients (95% CI 7.1-10.2), and under-triage persisted under messy notes and a noisy clinician. The agent was equally accurate under ideal conditions (99.6%) but 9.5% of its questions were irrelevant; with a noisy clinician it was less accurate than the bounds policy (83.5% vs 87.0%, p<0.001) and committed prematurely in 2.7% of cases (bounds: 0%). A 9B local model as extractor reached oracle-level accuracy (99.8%). In 584 real case reports from MedCalc-Bench, only 52% contained enough information to determine the category (HEART 13%). Routing decisions through code that reasons explicitly about unknowns avoids premature commitment and irrelevant questions, halves the questions asked, and works with small local models.

Nicolás Vera Zúñiga

Independent Researcher, Chile

Clinical Decision Support Learning with Missing Data Clinical Information Extraction Classification Clinical Risk Prediction

Sep 22, 2026cs.LG

A Leakage-Aware Multimodal Evaluation Framework for Early Intraoperative Acute Kidney Injury Prediction

Postoperative acute kidney injury (AKI) after major non-cardiac surgery carries substantial morbidity, yet early intraoperative risk stratification remains difficult. In this retrospective cohort study, we propose SynerT, a waveform-only hybrid temporal backbone that combines a causal dilated TCN with a hierarchy of dilated recurrent layers to encode early intraoperative physiologic trajectories for AKI risk prediction. Building on SynerT, we further design two model variants that extend the backbone with structured clinical context: SynerT-MM, a late-fusion multimodal extension that integrates hemodynamic burden summaries and preoperative covariates, and SynerTStack, a leakage-safe stacked ensemble that combines cross-validated predictions from SynerT-MM with strong tabular baselines at the meta-learning stage. All models are evaluated under a strict leakage-aware framework on VitalDB, a high-fidelity perioperative database, with prediction restricted to information available within the first 60 intraoperative minutes. Among 2,413 waveform-usable cases (180 AKI-positive; 7.46% prevalence), SynerT fell well below strong structured-data baselines, demonstrating that waveform-only temporal modeling is insufficient under strict early constraints. SynerTMM recovered discrimination by incorporating hemodynamic burden summaries and preoperative covariates, and SynerT-Stack achieved the best overall performance across AUROC, AUPRC, and F1-max. Cross-fitted Platt recalibration substantially corrected calibration defects in both multimodal variants, and decision-curve analysis confirmed the recalibrated stacked model delivered the strongest net clinical benefit across low-to-intermediate thresholds.

Quang Minh Nguyen, Duc Minh Le, Ho Nhat Minh Nguyen +2

National Economics University, Hanoi, Vietnam

Temporal Convolutional Networks Clinical Prediction Clinical Risk Prediction

Sep 21, 2026cs.AI

MedGate-Fusion: Integrating First-Encounter Semantic Narratives and Physiological Biomarkers for Prospective Stroke Risk Stratification

Prospective stroke risk stratification in primary care is challenging because early risk signals are distributed across routine biomarkers and unstructured clinical narratives. We propose MedGate-Fusion, a multi-modal gated architecture that integrates transformer-based embeddings of first-encounter narratives with ten routinely recorded risk markers. We used electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Starting from 808,921 encounter-level observations, we constructed a first-encounter cohort and retained 102,736 unique patient records with non-empty narratives and sufficient data to evaluate a five-year stroke outcome. To reduce explicit target leakage from diagnostic mentions in notes, we applied dictionary-based redaction of stroke-related terms prior to semantic encoding.

Hemn Khdr, Mohammad Noaeen, Karim Keshavjee +2

Dalla Lana School of Public Health, University of Toronto, Toronto, Canada · Department of Information Technology Management, Toronto Metropolitan University, Toronto, Canada · Faculty of Information, University of Toronto, Toronto, Canada +1

Multimodal Fusion Clinical Risk Prediction

Sep 21, 2026cs.LG

Pharmacokinetic State Space Models for Unbiased Prediction of Haemodynamic Collapse

An Intraoperative Hypotension (IOH) event is a frequent complication during administration of general anaesthesia with serious downstream consequences, yet clinical management remains reactive and not predictive. Existing predictive models, however, ignore drug infusion history as a valuable signal for prediction despite its direct pharmacological relevance. Our model achieves an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.7360 and an Area Under the Precision-Recall Curve (AUPRC) of 0.1794, representing a 2.73-fold lift over the random guessing AUPRC baseline (0.0657), with the removal of propofol and remifentanil effect-site concentrations resulting in a 13.9% AUPRC drop compared to the full model. This is consistent with the hypothesis that pharmacokinetic trajectories encode impending haemodynamic changes before they manifest in the Mean Arterial Pressure (MAP). Additionally, this paper shows that training without lead-gap filtering degraded AUROC by 16.7%, empirically confirming that unfiltered models learn to detect ongoing hypotension rather than predict future events. Finally, a Mamba-based architecture achieves the aforementioned high prediction performance while maintaining a constant memory footprint across a range of sequence lengths, unlike the quadratic VRAM overhead typical of vanilla Transformers, making it the more practical choice for continuous intraoperative deployment.

Rithin Nagaraj, Sudiksha Chindula, Bhaskarjyoti Das

Department of Computer Science and Engineering, PES University, Bengaluru, 560085, India · Department of Computer Science and Engineering (AIML), PES University, Bengaluru, 560085, India

Clinical Prediction Clinical Risk Prediction State Space Models

Sep 21, 2026cs.LG

Misaligned Clinical Risk Classification and Cost Asymmetry in Open-Weight Large Language Models

How large language models (LLMs) integrate patient risk with clinical cost tradeoffs remains poorly understood. We investigated how four open-weight LLMs (Qwen-2.5-7B/32B and Llama-3.1-8B/70B) internally represent cost tradeoffs, how these representations relate to clinical predictions, and whether decisions shift as predicted by the specified cost direction and magnitude. Using a public diabetes dataset, we varied 11 false-negative (FN) to false-positive (FP) cost ratios across three phrasings and examined representations and behavioral outputs. Patient risk was linearly recoverable on par with conventional classifiers (AUC

\approx 0.83

), and cost direction was recoverable in every model. However, representational shifts in cost direction tracked output changes only in the two larger models, and responses to cost magnitude were predominantly direction-agnostic. Only 2 of 12 model-phrasings showed both opposing responses to increasing FN versus FP costs and cost-correct ordering. Representationally, a direction fitted on one cost side did not invert when transferred to the other, as expected under mirror-symmetric encoding. These findings suggest that LLMs encode risk and cost information but do not reliably integrate them into cost-correct decisions. Clinical evaluations should therefore include tradeoff tests, phrasing sensitivity, and default operating points alongside predictive performance.

Star S. D. Liu, Xiyu Ding, Robert B. Barrett +3

Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA · Microsoft, Redmond, WA, USA · National Institutes of Health, Bethesda, MD, USA

Cost-Sensitive Learning LLM Interpretability Clinical Decision-Making Open-Weight Language Models Clinical Language Model Evaluation Clinical Risk Prediction

Sep 16, 2026eess.IV

Mammography Foundation Models for Opportunistic Prediction of Major Adverse Cardiovascular Events

Cardiovascular disease (CVD) remains the leading cause of death among women, yet cardiovascular risk assessment often relies on clinical variables that may be missing, outdated, or unavailable in routine care. Screening mammography offers an opportunity for opportunistic cardiovascular risk stratification because it is routinely acquired and contains vascular features, including breast arterial calcifications (BAC), that are associated with cardiovascular risk and events. We evaluate whether mammography specific foundation models, originally pretrained for breast cancer-related tasks, can transfer to cardiovascular risk prediction without cardiovascular specific supervision or explicit BAC annotation. We constructed a 5-year major adverse cardiovascular event (MACE) cohort of 22,497 women linked to electronic health record outcomes, including 500 events (2.22% prevalence). The foundation models achieved AUROCs of 0.823 and 0.822 substantially exceeding an age-only model (AUROC 0.765), despite using only the screening mammogram as input, with no clinical variables. Both foundation models evaluated assigned substantially higher predicted risk to patients with radiologist-documented BAC, despite BAC never being used as a training label, and showed activation patterns consistent with vascular findings. Together, these findings suggest that mammography foundation models can recover clinically relevant cardiovascular risk information directly from mammographic pixels and suggest that screening mammography may provide an opportunistic source of cardiovascular risk information to complement conventional clinical assessment without additional imaging. Code is available in https://github.com/PauFeld/MammoCVD

Paula Feldman, Nusrat Binta Nizam, Sunwoo Kwak +3

Department of Radiology, Weill Cornell Medicine, New York, NY, USA · Cornell Tech, New York, NY, USA · Cornell University, New York, NY, USA

Medical Imaging Foundation Models Clinical Outcome Prediction Mammography Clinical Risk Prediction

Sep 14, 2026cs.LG

Knowledge-Enriched Structured EHR Features for 30-Day Hospital Readmission Prediction on MIMIC-IV

Recent approaches to 30-day hospital readmission prediction rely on pre-trained language models applied to discharge summaries. Although these methods achieve strong performance, they depend on the availability of clinical notes, incur substantial computational costs, and yield representations that lack interpretability. We propose a knowledge-enriched feature representation that augments structured Electronic Health Record (EHR) data with four medical knowledge sources: disease ontology mapping, procedure classification, drug ingredient vocabulary, and organ system laboratory aggregation, without using clinical notes. Each feature dimension corresponds to a named clinical concept, yielding a sparse and interpretable patient representation. The approach is evaluated with six classifiers on a MIMIC-IV v2.2 cohort. Under 20-fold cross-validation, the best configuration achieves an AUROC of 0.743. This performance is comparable to that of previously reported methods on this dataset, including both those using only structured data and those incorporating clinical notes, while requiring considerably less computational cost. Interpretability analysis shows that demographics, organ system labs, drug ingredient features, and first-level ontology disease categories drive prediction, while deeper hierarchy levels contribute negligibly. These findings indicate that knowledge-enriched structured features offer a competitive and efficient alternative to embeddings from clinical notes for 30-day readmission prediction.

Mohamad Najafi, Hongyun Fu, Mathias Brochhausen +2

Old Dominion University, Virginia, USA · University of Arkansas for Medical Sciences, Arkansas, USA

Clinical Outcome Prediction Electronic Health Records Automated Feature Engineering Clinical Risk Prediction

Sep 14, 2026cs.LG

Patient-Reported Survey Data Improve Prediction of Opioid Use Disorder

Electronic health records (EHRs) may incompletely capture patient-reported factors associated with opioid use disorder (OUD). We evaluated whether survey data improve prediction of a first recorded OUD diagnosis among 267,747 All of Us participants with documented opioid exposure, including 15,287 OUD cases. We compared EHR-only and EHR+survey models across 6-, 12-, and 24-month look-back windows using logistic regression, random forest, XGBoost, LightGBM, multilayer perceptron, LSTM, GRU, and Transformer. Survey augmentation improved PR-AUC across all 24 model-window combinations by 0.0087-0.0505; the best 24-month LightGBM model improved from 0.6219 to 0.6603. Survey coverage increased with longer windows and differed by OUD status (24 months: 21.7% OUD-positive vs. 60.7% OUD-negative). Permutation analysis ranked survey features as the second most important information domain at 24 months in both evaluated models. Patient-reported data provide complementary predictive signals beyond structured EHRs while highlighting the importance of survey availability.

Xiyue Jiang, Zihan Ding, Grace Han +3

Department of Applied Mathematics & Statistics, Stony Brook University, Stony Brook, NY, USA · Department of Computer Science, Stony Brook University, Stony Brook, NY, USA · Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA +1

Clinical Outcome Prediction Electronic Health Records Clinical Risk Prediction

Sep 14, 2026cs.LG

Optimizing for the decision not the prediction: an exploration of Smooth Net Benefit as a training objective

Objective Prediction models are commonly trained using objectives such as Bernoulli negative log-likelihood (NLL), although downstream clinical decisions may depend on specific risk thresholds. We introduce Smooth Net Benefit (

\sigma

NB), a differentiable approximation of Net Benefit designed to align model training with threshold-specific clinical utility. Materials and Methods We evaluated

\sigma

NB as a training objective for logistic regression, generalized additive models (GAMs), and XGBoost with three Hessian implementations. Experiments used the Framingham cardiovascular risk dataset and 44 TabZilla datasets comprising 72 dataset-threshold combinations. Results

\sigma

NB training did not consistently improve Net Benefit in Framingham. Across the TabZilla benchmark, mean standardized Net Benefit for logistic regression increased from 0.5669 with NLL to 0.5765 with

\sigma

NB (mean difference 0.0096, 95% CI -0.0001 to 0.0193). For GAMs, mean standardized Net Benefit decreased from 0.5921 to 0.5625 (mean difference -0.0296, 95% CI -0.0721 to 0.0129). For XGBoost, NLL achieved 0.6745 compared with 0.6723--0.6735 across

\sigma

NB implementations. In logistic regression,

\sigma

NB gains were positively associated with the performance advantage of XGBoost over NLL-trained logistic regression. Discussion The effect of

\sigma

NB was context dependent, with modest gains concentrated in logistic regression and little benefit for more flexible model classes. This suggests that decision-focused optimization may be most useful when limited model flexibility leaves greater scope for improvement. Conclusion Our results do not support

\sigma

NB as a general replacement for NLL training, but support further investigation of decision-focused objectives in settings where conventional likelihood-based training may not adequately capture decision-relevant structure.

Koen M. F. Gorgels, Lasai Barreñada, Maarten van Smeden +3

Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands · Coo peratie VGZ, Arnhem, the Netherlands · Department of Development and Regeneration, KU Leuven, Leuven, Belgium

Predict-Then-Optimize Decision-Focused Learning Clinical Decision-Making Clinical Risk Prediction

Sep 11, 2026cs.CL

Target leakage, not model class, explains reported accuracy in survey-based cardiovascular screening: a leakage-tiered audit of glass-box and tabular foundation models

Cardiovascular screening models trained on national health surveys routinely report areas under the receiver operating characteristic curve (AUROC) near 0.89. We asked whether that accuracy reflects learning or target leakage, whether tabular foundation models change the answer, and whether the properties deployment requires survive joint examination. We benchmarked ten classifiers spanning linear, tree-ensemble, neural, glass-box, and tabular foundation classes for prevalent myocardial infarction in 442,067 respondents of the 2022 Behavioral Risk Factor Surveillance System across five feature tiers of decreasing leakage risk. Each was audited for discrimination, calibration, fairness at an explicit screening threshold, conformal coverage, explanation faithfulness, and inference cost, then applied -- models and thresholds frozen -- to 430,755 respondents of 2023. Removing two post-diagnostic features cost every model 0.049-0.051 AUROC, collapsing the field into a 0.0045-wide band. The glass-box explainable boosting machine was non-inferior to every alternative within a pre-specified 0.005 margin while scoring the cohort roughly 104 times faster than the strongest foundation model. One threshold detected 75.4% of women's infarctions against 89.0% of men's; editing the model's shape functions reduced the gap to 0.010. Marginal conformal prediction gave 0.86 coverage to men and 0.82 to adults over 60; Mondrian calibration repaired every stratum. Frozen models transported within 0.002 AUROC. Reported headroom in this literature is a property of the feature set, not the learner. Transparency cost nothing measurable and made fairness repair and uncertainty conditioning directly auditable. Evaluation practice, not model capacity, is the binding constraint.

Raad Bin Tareaf, Murad Al-Rajab, Samia Loucif +2

Data Science and AI Cluster, XU Exponential University of Applied Sciences, Potsdam, Germany · German University of Digital Science, Potsdam, Germany · College of Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates +2

Data Leakage Tabular Foundation Models Interpretable ML Clinical Risk Prediction

Sep 9, 2026cs.CY

Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support

Background: Emergency Department (ED) return visits are commonly reviewed for quality assurance, but are often limited (e.g., to revisits within 48-72 hours) to increase actionable finding yield while minimizing chart review burden. Those limitations may lead to missed quality improvement opportunities. Methods: We conducted an exploratory, retrospective study of randomly selected ED visits to a multihospital health system having an ED revisit within 1-14 days to the same health system. Given only each visit's primary diagnosis, raters (2-3 clinicians and GPT-4 large language model [LLM]) assessed characteristics of the diagnosis pairs, including the "target": whether a pair warranted further assessment. Informed by rater response analyses, an algorithm leveraging an LLM-populated knowledge graph ("KGA") was created to automatically screen for potentially concerning pairs, then preliminarily assessed. Results: 99 diagnosis pairs were included. GPT-4 responses poorly correlated to clinician raters, rating nearly all (94%) pairs as warranting follow-up (4.4-13.3 times more than clinicians). However, prompt engineering was minimal. Among clinician raters, revisit medical gravity was consistently significantly associated with the target, while a differential diagnosis/complication composite was significantly associated on unadjusted, but not adjusted (though less powered) analysis. The KGA achieved 83-100% positive predictive value for at least one clinician rater determining further assessment was warranted based on the diagnosis pair. Conclusion: These results can inform next steps for improving screening with LLMs like ChatGPT. Further research is warranted to validate this preliminary work's finding that the KGA may enable enhancing the scope and yield of screening without substantially increasing reviewer workload.

Jonathan A. Handler, Marlene I. Robles-Granda, Jacob E. Mefford +5

Clinical Intelligence and Advanced Data Lab, OSF HealthCare, Peoria, IL · Digital Innovation Development, OSF HealthCare, Peoria, IL · OnCall, OSF HealthCare, Peoria, IL +7

Clinical Decision Support Clinical Decision-Making Human-AI Decision Making Clinical Language Model Evaluation Knowledge Graphs Clinical Risk Prediction

Sep 9, 2026cs.LG

In Medical Claims Data, Enhancing Predictive Performance for Major Adverse Cardiovascular Events Using Cross Attention

Medical claims data comprise the financial details, including the expenses and billing information, as well as the clinical information, such as the diagnoses and treatments, of patients visiting medical facilities. Recently, it has been acknowledged that large databases can be constructed from medical claims data for medical research purposes. However, the clinical information within these datasets is often medically unstructured, limiting its application in comprehensive analyses. This study enhances predictive model performance for major adverse cardiovascular events (MACE), a leading cause of death worldwide. Models that predict MACE are crucial to clinical practice guidelines. We utilize a cross-attention mechanism to develop a method that effectively weights the relationships between diagnoses and treatments. Effectively repre- senting the clinical information contained in medical claims data, this approach generates more representative features for predicting MACE. The ROC-AUC score of our proposed cross-attention-based model was 0.7720, higher than other benchmark models including the conventional atherosclerotic cardiovascular disease model, the light gradient boosting machine, and a self-attention-based model. These results indicate that integrating the clinical structure of medical claims data using a cross-attention mechanism significantly enhances the performance of predictive models.

Yuhei Fujioka, Daitaro Misawa, Tatsuyoshi Ikenoue +1

Human Health Sciences, Kyoto University Graduate School of Medicine · Cancerscan Inc. Tokyo, Japan · Data Science and AI Innovation Research Promotion Center, Shiga University Shiga, Japan

Clinical Outcome Prediction Clinical Risk Prediction

Sep 8, 2026cs.LG

Geographically Regularized AUC-Maximizing Personalized Federated Learning

Accurate diagnostic and risk-prediction models are important for supporting clinical decision-making during infectious disease outbreaks. However, privacy and governance requirements may restrict patient-level data sharing across healthcare institutions, and data distributions often vary. Moreover, AUC is widely used to evaluate discriminative performance, motivating its direct optimization in model development. We propose geographically regularized AUC-maximizing personalized federated learning (GrAUC-PFL), which directly optimizes a smooth pairwise AUC surrogate to learn personalized models while keeping patient-level data local and accounting for institutional heterogeneity. Graph-based regularization encourages geographically neighboring institutions to have similar coefficient vectors while retaining a personalized models. Simulations and a real-data application suggest improved discriminative performance, particularly when geographically neighboring institutions have similar data-generating characteristics.

Mayu Hiraishi, Kensuke Tanioka, Toshio Shimokawa

Department of Medicine · Wakayama Medical University · Wakayama, Japan +3

Clinical Risk Prediction Federated Learning Heterogeneous Federated Learning

Sep 7, 2026cs.CL

Bag of Tricks or Bag of Myths? Reducing Modeling Complexity with Task Knowledge in Explainable Suicide Risk Assessment

Assessing suicide risk from social media text is a small-data, high-stakes setting requiring not only severity prediction but also supporting evidence and clinically relevant risk and protective factors. Yet common NLP techniques, including model scaling, synthetic data, loss reweighting, ensembling, and threshold tuning, are often applied without testing whether their gains hold up under severe class imbalance, coupled outputs, and limited author-level data. We study 1,635 clinician-annotated posts and audit 31 pre-specified techniques from 7 methodological families through roughly 300 controlled experiments on author-disjoint partitions. We found no prior audit of this playbook in this regime. The findings guide a task-grounded system for three outputs: 4-level suicide risk, evidence spans, and 24 clinical risk and protective factors. Only 5 of 31 comparisons produced reliable gains. We reformulate factor prediction as entailment between each post and its codebook definitions, using an architecturally diverse ensemble with class-balanced training and score rescaling. Risk predictions condition a 7-model evidence tagger ensemble; evidence restricts symbolic risk rules; and a difficult risk class is routed separately. The factor predictor remains independent because risk evidence provides no additional factor signal. We also correct a mismatch between validation scores used for threshold fitting and test-time ensemble scores through deployment-consistent calibration, yielding the largest improvement to the factor system. The final system achieves 0.8203 for risk, 0.7953 for evidence, and 0.7045 macro-F1 for factors, with a 0.7781 composite, ranking third among 53 teams. We call the underlying principle task-conditioned technique selection: retain techniques only when task-specific knowledge, structure, or empirical evidence justifies them.

Shlok Shelat, Shrey Salvi, Souvik Roy +2

Indian AI Research Organisation · Ahmedabad University · University of Maryland, Baltimore County

Language Model Ensembles Suicide Risk Modeling Clinical NLP Clinical Risk Prediction

Sep 7, 2026cs.LG

Translation of Black-Box Clinical Prediction Models into Standalone Transparent Nomograms: Temporal External Validation in Heart Transplantation

We convert black-box clinical prediction models for tabular data into standalone nomograms that can be audited term by term. PRiSM (Partial Responses in Structured Models) takes the shape of each effect and interaction from the source model, not merely which variables mattered, and lets the outcome select and weight them. We tested this in 50,356 heart transplant recipients, with validation in a later era than training. Nomograms from all 5 source models - a public clinical risk score, logistic regression, neural networks, random forests and extreme gradient boosting - met a prespecified noninferiority criterion for discrimination before any further simplification, and generally preserved calibration and clinical net benefit. Those from the 3 machine-learning models showed no detectable difference in discrimination from de novo generalized additive and explainable boosting models, exceeded neural additive models, and carried fewer terms than the explainable boosting model. PRiSM is released as an open-source Python package.

Henry Pigot, Paulo J. G. Lisboa, Sandra Ortega-Martorell +3

Department of Translational Medicine, Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences Research Unit, Lund University, Lund, Sweden · Artificial Intelligence and Digital Technologies Research Institute, Liverpool John Moores University, Liverpool, UK · Department of Thoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden

Surrogate Modeling Healthcare Interpretable ML Clinical Prediction Clinical Risk Prediction

Aug 31, 2026cs.CL

Assessing Suicide Risk in Arabic Crisis Helpline Calls: A Comparison of Arabic and English Large Language Models

Crisis helplines assess suicide risk through structured interviews, a process that is slow and dependent on operator training and workload. Natural language processing could support risk assessment and call prioritization, but almost no work addresses Arabic-language helpline calls or operates within the privacy constraints of real helpline data. We analysed de-identified transcripts from Lebanon's National Lifeline for Emotional Support and Suicide Prevention. Audio never left the helpline: calls were transcribed on site with a speech recognition model for Levantine Arabic, and an Arabic named-entity recognition model removed identifying information locally. Only the de-identified transcripts were shared with the research team. Operators recorded the five suicidal ideation items of the Columbia Suicide Severity Rating Scale, which we combined into two binary outcomes: at-risk and high-risk. We also machine-translated the transcripts into English, giving a paired Arabic/English comparison. On each corpus, we fine-tuned five instruction-tuned large language models alongside six transformer encoder baselines (four Arabic, two English) and evaluated all models on a held-out test set. We included 383 calls: 373 for the at-risk task (52.3% positive) and 297 for the high-risk task (30.0% positive). The best Arabic model reached a macro-F1 of 81.19 and a ROC-AUC of 90.61 on high-risk; the best English model reached 85.00 and 92.59, identifying 88.9% of high-risk calls. In both languages, high-risk calls separated more cleanly than at-risk calls, and translation to English did not reduce the best observed performance. Suicide risk can be classified from de-identified Arabic transcripts without sending audio outside the helpline. The high-risk results support further testing as an operator-facing tool; lower-severity ideation proved the harder case.

Linhai Ma, Rita El Hachem, Mahatab El Hajj +2

Department of Emergency Medicine, Yale University, New Haven, CT, USA. · Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon. · Embrace, Mental Health Center, Beirut, Lebanon.

Multilingual Language Model Evaluation Arabic NLP Suicide Risk Modeling Clinical NLP Clinical Risk Prediction

Aug 31, 2026cs.CL

DIASENTINEL: An Auditable Multi-Agent System for Guideline-Grounded Diabetes Risk Screening

Large language models (LLMs) offer promising clinical decision support but remain vulnerable to hallucinated facts, unsupported recommendations, and citation errors. We present DIASENTINEL, a fully on-premise multi-agent system for one-year type 2 diabetes mellitus (T2DM) risk screening and guideline-grounded report generation from electronic health records (EHRs). The system integrates calibrated risk prediction, deterministic clinical signal extraction, Reciprocal Rank Fusion over American Diabetes Association (ADA) guidelines, and a hybrid verification layer combining rule-based checks with LLM entailment. The demonstration provides a real-time batch-screening dashboard and an interactive patient report interface with cited recommendations, verification results, and raw EHR comparison. DIASENTINEL demonstrates a practical framework for reliable, auditable, and privacy-preserving LLM-based clinical decision support.

Yung Wei Shueh, Zhi-Jie Chen, Chia-Hsuan Hsu +9

Far Eastern Memorial Hospital, Taiwan · University of Michigan, USA · Rutgers University, USA +1

Multi-Agent LLM Systems Medical Report Generation LLM Auditing Clinical Decision Support Clinical Risk Prediction

Aug 11, 2026cs.CV

Gaussian Meta-Space Augmentation for Stacking Ensembles in Multimodal IPMN Risk Stratification

Pancreatic cancer is among the most lethal malignancies; risk stratification of intraductal papillary mucinous neoplasms (IPMNs) offers a crucial opportunity for early intervention but typically requires invasive tissue biopsy. Dominant vision-based approaches, including radiomics and deep learning, provide promising but initially separate discrimination opportunities. Similarly, multisequence MRI (T1W/T2W) and anatomically decomposed (head, body and tail) analysis of the pancreas provide additional and potentially complementary signals. Effective fusion of this information is crucial in ordinal IPMN dysplasia risk prediction and can be accomplished via a meticulously regularized and calibrated ensemble stacking combiner. We present cUPMI, a class-conditional Gaussian augmentation of a combiner's log-probability meta-features, and test it on various prediction paradigms. In our multi-center analysis, we find cUPMI adds limited value to properly regularized L2-logistic binary classification stacks, but consistently regularizes higher-capacity tree combiners in the binary and radiomics-only setting (RF +0.015 and XGBoost +0.024 binary AUC, positive in all seeds). Its cleanest ordinal benefit appears for XGBoost on an 8-stream radiomics task (3-class no < low < high, +0.022 QWK in all seeds). Separately, fold-locked fusion of radiomics and 2.5D CNN streams yields the strongest overall model, an RF stack reaching QWK 0.595 (95% CI [0.54, 0.64]) and binary AUC 0.839, surpassing radiomics, 2.5D ResNet, and 3D DenseNet-121 baselines.

Max A. Nelson, Eminenur Sen Tasci, Zhixiang Wang +12

Machine & Hybrid Intelligence Lab, Department of Radiology, Northwestern University, Chicago, IL, USA · Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA · Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey +2

Ensemble Learning Ordinal Regression Oncology Radiomics Multimodal Fusion Clinical Risk Prediction

Aug 9, 2026cs.LG

A Domain-Structured Ensemble Framework for Perioperative Outcome Prediction Using Electronic Health Record Data

Perioperative risk prediction models are often limited by narrow surgical populations, incomplete intraoperative data, poor calibration, and limited interpretability. We present a domain-structured ensemble framework for perioperative outcome prediction using routinely collected electronic health record (EHR) data. Predictors are organized into patient-related, surgery-related, and anesthetics-related domains. Domain-specific gradient boosting models generate independent risk estimates that are integrated through a logistic regression meta-learner. We demonstrate the framework using postoperative delirium (POD) in a case-control sample of 5,386 surgical encounters (2,693 cases, 2,693 controls) from a statewide health information exchange. POD required both delirium-related ICD codes and a positive Confusion Assessment Method screening within seven postoperative days; patients with preexisting dementia were excluded. The stacked meta-learner achieved AUROC 0.899 (95% CI: 0.891-0.906), precision-recall AUC 0.881, and Brier score 0.126, compared with AUROC 0.849 for the best single-stage model. Domain ablation showed improved discrimination and calibration over a surgery-only model (AUROC 0.879, Brier 0.140). Temporal validation on held-out post-2017 data yielded AUROC 0.915. Calibration was excellent, with intercept -0.006 (95% CI: -0.083 to 0.070) and slope 1.035 (95% CI: 0.982 to 1.088). Decision curve analysis, corrected for case-control sampling, showed positive net benefit across clinically plausible thresholds. The modular framework supports alternative outcomes, extension of predictor domains, and dynamic risk updating, providing a scalable foundation for interpretable, calibration-aware perioperative clinical decision support.

Shikhar Shukla, Cristina Barboi

BioHealth Informatics Indiana University Indianapolis Indianapolis, USA · Department of Anesthesiology Indiana University School of Medicine Indianapolis, USA

Ensemble Learning Clinical Outcome Prediction Clinical Risk Prediction

Aug 4, 2026cs.LG

A Comparative Study of Feature Selection Methods for EHR Diagnosis Codes in Opioid Use Disorder Prediction

Feature selection is a critical step in electronic health record (EHR)-based predictive modeling, where input variables are often high-dimensional, sparse, noisy, and redundant. Large feature sets not only increase computational burden and overfitting risk, but also make model interpretation difficult, leading to limited usefulness in clinical settings. In this study, we focus on diagnosis-related features and compare five feature selection paradigms for opioid use disorder (OUD) prediction: recurrence enrichment, NTK-motivated early gradient sensitivity, LightGBM-SHAP, Elastic Net, and large language model (LLM)-guided semantic selection. We use a unified preprocessing and evaluation framework and assess each method by downstream predictive performance, resampling stability, and representation of infrequent diagnosis codes. Our results demonstrate that performance improves with larger feature budgets with diminishing returns beyond a moderate size. NTK sensitivity provides the best overall balance of accuracy and stability, and LLM-guided selection contributes complementary clinically meaningful signals despite lower standalone performance.

Zihan Ding, Yinan Liu, Tengfei Ma +6

Stony Brook University · Rutgers University · University of Vermont

Clinical Outcome Prediction Feature Selection Clinical Risk Prediction