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

Apr 27, 2026cs.LG

Dialysis Risk Prediction and Treatment Effect Estimation for AKI patients using Longitudinal Electronic Health Records

Progression to dialysis or end-stage renal disease is a rare but clinically important outcome. Clinicians need evidence on how medication exposures influence downstream risk. We constructed a fixed-window EHR cohort (90-day observation, 730-day prediction; N=81401; dialysis/ESRD prevalence: 1.1%) and modeled sequences of diagnoses, procedures, and medications with kidney laboratory trends (creatinine, BUN, eGFR). A transformer-based causal multi-head model was trained to estimate drug- and ingredient-level average treatment effects (ATEs) using counterfactual exposure removal and insertion under a full medication history setup. On test set, predictive performance reached an AUC of 0.694 and PR-AUC of 0.094. At the selected decision threshold (0.883), the model achieved an F1 score of 0.201 with a Brier score of 0.018. Post-hoc causal analyses of lab changes (eGFR, creatinine, BUN) using IPTW, AIPW, naive, and covariate-adjusted OLS methods assessed clinical directionality. Results showed partial protective-direction support for ACE/ARB exposures and worsening-direction signals for loop diuretics.

Kalyani P. Pande, Evan Yang, Bryan Zhu +3

Stony Brook University, Stony Brook, NY, USA

Causal Effect Estimation Healthcare Longitudinal EHR Modeling Clinical Risk Prediction

Apr 26, 2026cs.MA

EndoGov: A knowledge-governed multi-agent expert system for endometrial cancer risk stratification

Multimodal artificial intelligence models for endometrial cancer (EC) risk stratification typically optimize aggregate predictive performance but provide limited mechanisms for enforcing mandatory guideline overrides, such as assigning POLE-mutated tumors to the low-risk group despite high-grade morphology. We present EndoGov, a two-tier multi-agent expert system that factorizes the decision process as D(x) = G(P(x), R), where specialist agents P extract structured evidence and a governance agent G applies an executable rule set R. Tier 1 comprises pathology, molecular, and clinical agents that independently generate schema-constrained reports from frozen foundation-model features or structured records. Tier 2 queries an evidence-level-weighted Guideline Knowledge Graph, using deterministic hard-path rules for high-priority overrides and constrained soft-path reasoning for ambiguous cases. In TCGA-UCEC (n=541), EndoGov achieved 0.943 accuracy, 0.973 macro AUC, and a conditional logic-violation rate (C-LVR) of 0.93% among trigger-exposed cases. In CPTAC-UCEC (n=95), where reference labels are guideline-derived, EndoGov reached 0.842 accuracy compared with < 0.31 for locked-transfer neural baselines, supporting governance-pathway transfer under distribution shift rather than validation against independent clinical truth. End-to-end safety decomposition localized residual failures primarily to upstream molecular detection rather than downstream governance. Backend-swap experiments further showed that hard-path compliance is invariant to the LLM backend. These findings indicate that explicit clinical-rule governance can provide guideline-compliant, auditable EC risk assignment while preserving competitive discrimination.

Weiye Dai, Liyun Shi, Zanxiang He +4

aShenzhen Technology University, Shenzhen, China · bShenzhen People’s Hospital, Shenzhen, China · dShenzhen University, Shenzhen, China +1

Clinical Decision Support Multi-Agent Systems Oncology AI Agent Governance Clinical Risk Prediction

Apr 26, 2026cs.LG

Impact of Age Specialized Models for Hypoglycemia Classification

Disease progression varies with age and is influenced by underlying genetic, biochemical, and hormonal etiologies, suggesting the need for tailored monitoring, care, and medication beyond standard clinical guidelines. Specifically, in autoimmune diseases like type 1 diabetes (T1D), where patients depend on exogenous insulin to compensate for insulin deficiency, medication dosing and the physiological response reflected in vital signs can differ. Insulin therapy can lead to hypoglycemia, a dangerous condition characterized by decreased blood glucose levels (

\leq

70). This risk can be mitigated through improved diabetes management supported by data analytics. Notably, leveraging data from continuous glucose monitoring (CGM) devices, hypoglycemia onset can be predicted. However, while glucose variability, auto-antibody levels, and hypoglycemia occurrence differ across age groups, hypoglycemia classification most often only relies on population-based models specialized in specific age ranges. In this work, we classify hypoglycemia 0, 5-15, 20-45, and 50-120 minutes before onset using DiaData, a large CGM dataset of patients with T1D ranging from children to seniors. In particular, we investigate: 1) the generalizability of a population-based model including all age groups, 2) the impact of age-segmented models trained separately per age group, and 3) the effect of model individualization through transfer learning. The results show that a global population-based model yields similar or superior performance compared to age-segmented models. These findings suggest that data from children, teenagers, and adults can be combined for training models on hypoglycemia classification. While glucose variation differs across age groups, short-term hypoglycemic patterns are similar. However, data of children obtain their best recall with age specialized model.

Beyza Cinar, Maria Maleshkova

Data Engineering · Helmut Schmidt University · Germany

Type 1 Diabetes Time Series Classification Transfer Learning Clinical Prediction Clinical Risk Prediction

Apr 24, 2026cs.LG

Reliable Self-Harm Risk Screening via Adaptive Multi-Agent LLM Systems

Emerging AI systems in behavioral health and psychiatry use multi-step or multi-agent LLM pipelines for tasks like assessing self-harm risk and screening for depression. However, common evaluation approaches, like LLM-as-a-judge, do not indicate when a decision is reliable or how errors may accumulate across multiple LLM judgements, limiting their suitability for safety-critical settings. We present a statistical framework for multi-agent pipelines structured as directed acyclic graphs (DAGs) that provides an alternative to heuristic voting with principled, adaptive decision-making. We model each agent as a stochastic categorical decision and introduce (1) tighter agent-level performance confidence bounds, (2) a bandit-based adaptive sampling strategy based on input difficulty, and (3) regret guarantees over the multi-agent system that shows logarithmic error growth when deployed. We evaluate our system on two labeled datasets in behavioral health : the AEGIS 2.0 behavioral health subset (N=161) and a stratified sample of SWMH Reddit posts (N=250). Empirically, our adaptive sampling strategy achieves the lowest false positive rate of any condition across both datasets, 0.095 on AEGIS 2.0 compared to 0.159 for single-agent models, reducing incorrect flagging of safe content by 40% and still having similar false negative rates across all conditions. These results suggest that principled adaptive sampling offers a meaningful improvement in precision without reducing recall in this setting.

Meghana Karnam, Ananya Joshi

Johns Hopkins University Baltimore, USA

AI Agent Reliability Multi-Agent LLM Systems Healthcare Mental Health Clinical Risk Prediction LLM Agent Reliability

Apr 23, 2026cs.LG

Reliability Auditing for Downstream LLM tasks in Psychiatry: LLM-Generated Hospitalization Risk Scores

Large language models (LLMs) are increasingly utilized in clinical reasoning and risk assessment. However, their interpretive reliability in critical and indeterminate domains such as psychiatry remains unclear. Prior work has identified algorithmic biases and prompt sensitivity in these systems, raising concerns about how contextual information may influence model outputs, but there remains no systematic way to assess these, especially in the psychiatric domain. We propose an approach for reliability auditing downstream LLM tasks by structuring evaluation around the impact of prompt design and the inclusion of medically insignificant inputs on predicted hospitalization risk scores, which is often the first downstream AI clinical-decision-making task. In our audit, a cohort of synthetic patient profiles (n = 50) is generated, each consisting of 15 clinically relevant features and up to 50 clinically insignificant features, across four prompt reframings (neutral, logical, human impact, clinical judgment). We audit four LLMs (Gemini 2.5 Flash, LLaMa 3.3 70b, Claude Sonnet 4.6, GPT-4o mini), and our results show that including medically insignificant variables resulted in a statistically significant increase in the absolute mean predicted hospitalization risk and output variability across all models and prompts, indicating reduced predictive stability as contextual noise increased. Clinically insignificant features had an effect on instability across many model-prompt conditions, and prompt variations independently affected the trajectory of instability in a model-dependent manner. These findings quantify how LLM-based psychiatric risk assessments are sensitive to non-clinical information, highlighting the need for systematic evaluations of attributional stability and uncertainty behavior like this before clinical deployments.

Shevya Panda, Shinjini Bose, Ananya Joshi

Johns Hopkins University Baltimore, USA

Prompt Sensitivity LLM Auditing Mental Health Clinical Language Model Evaluation Clinical Risk Prediction

Apr 22, 2026cs.LG

Causal-Transformer with Adaptive Mutation-Locking for Early Prediction of Acute Kidney Injury

Accurate early prediction of Acute Kidney Injury (AKI) is critical for timely clinical intervention. However, existing deep learning models struggle with irregularly sampled data and suffer from the opaque "black-box" nature of sequential architectures, strictly limiting clinical trust. To address these challenges, we propose CT-Former, integrating continuous-time modeling with a Causal-Transformer. To handle data irregularity without biased artificial imputation, our framework utilizes a continuous-time state evolution mechanism to naturally track patient temporal trajectories. To resolve the black-box problem, our Causal-Attention module abandons uninterpretable hidden state aggregation. Instead, it generates a directed structural causal matrix to identify and trace the exact historical onset of severe physiological shocks. By establishing clear causal pathways between historical anomalies and current risk predictions, CT-Former provides native clinical interpretability. Training follows a decoupled two-stage protocol to optimize the causal-fusion process independently. Extensive experiments on the MIMIC-IV cohort (N=18,419) demonstrate that CT-Former significantly outperforms state-of-the-art baselines. The results confirm that our explicitly transparent architecture offers an accurate and trustworthy tool for clinical decision-making.

Weizhi Nie, Haolin Chen

School of Electrical and Information Engineering, Tianjin University

Causal Interpretability Longitudinal EHR Modeling Sequence Modeling Clinical Risk Prediction

Apr 22, 2026cs.LG

Clinically Interpretable Sepsis Early Warning via LLM-Guided Simulation of Temporal Physiological Dynamics

Timely and interpretable early warning of sepsis remains a major clinical challenge due to the complex temporal dynamics of physiological deterioration. Traditional data-driven models often provide accurate yet opaque predictions, limiting physicians' confidence and clinical applicability. To address this limitation, we propose a Large Language Model (LLM)-guided temporal simulation framework that explicitly models physiological trajectories prior to disease onset for clinically interpretable prediction. The framework consists of a spatiotemporal feature extraction module that captures dynamic dependencies among multivariate vital signs, a Medical Prompt-as-Prefix module that embeds clinical reasoning cues into LLMs, and an agent-based post-processing component that constrains predictions within physiologically plausible ranges. By first simulating the evolution of key physiological indicators and then classifying sepsis onset, our model offers transparent prediction mechanisms that align with clinical judgment. Evaluated on the MIMIC-IV and eICU databases, the proposed method achieves superior AUC scores (0.861-0.903) across 24-4-hour pre-onset prediction tasks, outperforming conventional deep learning and rule-based approaches. More importantly, it provides interpretable trajectories and risk trends that can assist clinicians in early intervention and personalized decision-making in intensive care environments.

Weizhi Nie, Zhen Qu, Weijie Wang +4

School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072, Tianjin, China · Department of Information Engineering and Computer Science, University of Trento, Trento, Trentino, Italy · Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China +3

Interpretable ML LLM-Based Time Series Forecasting Spatiotemporal Forecasting Clinical Risk Prediction

Apr 22, 2026cs.LG

Validating a Deep Learning Algorithm to Identify Patients with Glaucoma using Systemic Electronic Health Records

We evaluated whether a glaucoma risk assessment (GRA) model trained on All of Us national data can identify patients at high probability of glaucoma using only systemic electronic health records (EHR) at an independent institution. In this cross-sectional study, 20,636 Stanford patients seen from November 2013 to January 2024 were included (15% with glaucoma). A pretrained GRA model was fine-tuned on the Stanford cohort and tested on a held-out set using demographics, systemic diagnoses, medications, laboratory results, and physical examination measurements as inputs. The best model achieved AUROC 0.883 and PPV 0.657. Calibration was consistent with clinical risk: the highest prediction decile showed the greatest glaucoma diagnosis rate (65.7%) and treatment rate (57.0%). Performance improved with more trainable layers up to 15 and with additional data. An EHR-only GRA model may enable scalable and accessible pre-screening without specialized imaging.

John Xiang, Rohith Ravindranath, Sophia Y. Wang

Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California, USA

Clinical Risk Prediction

Apr 21, 2026cs.CL

LLMs for Cardiovascular Risk Prediction from Structured Clinical Data

Coronary artery disease (CAD) remains one of the leading causes of death globally, highlighting the need for reliable predictive systems to support early diagnosis and risk assessment. While traditional machine learning models perform well on structured clinical data, large language models (LLMs) present new possibilities to interpret medical information expressed in natural language. In this work, we develop a hybrid framework that bridges structured clinical data and natural-language representations for CAD prediction. Using a publicly available dataset of 1,190 patient records with 11 clinical attributes, structured variables are converted into interpretable feature representations and synthetic clinical narratives using LLMs. A validation pipeline performs reverse extraction of clinical variables and computes a consistency score with the original records, achieving an average fidelity of 94.61%. We then evaluate four conventional machine learning models and compare their performance with LLM-based classification under zero-shot and few-shot prompting settings. We use two LLMs here, GPT and Gemini. Experimental results show that Random Forest achieves the highest accuracy. Despite this advantage, LLM-based classification remains beneficial in real-world clinical settings. This is because LLMs operate directly on natural language patient descriptions, meaning that sensitive numerical patient data such as exact lab values, blood pressure readings, and diagnostic codes are kept private. Findings suggest that combining structured clinical data with LLM-generated narratives can enable new directions for hybrid clinical prediction systems.

Jeba Maliha, Md Rafiul Kabir

Central Michigan University, Mount Pleasant, MI, USA

Medical LLMs Clinical Risk Prediction

Apr 20, 2026cs.CV

REVEAL: Multimodal Vision-Language Alignment of Retinal Morphometry and Clinical Risks for Incident AD and Dementia Prediction

The retina provides a unique, noninvasive window into Alzheimer's disease (AD) and dementia, capturing early structural changes through morphometric features, while systemic and lifestyle risk factors reflect well-established contributors to disease susceptibility long before clinical symptom onset. However, current retinal analysis frameworks typically model imaging and risk factors separately, limiting their ability to capture joint multimodal patterns critical for early risk prediction. Moreover, existing methods rarely incorporate mechanisms to organize or align patients with similar retinal and clinical characteristics, constraining the learning of coherent cross-modal associations. To address these limitations, we introduce REVEAL (REtinal-risk Vision-Language Early Alzheimer's Learning), a framework that aligns color fundus photographs with individualized disease-specific risk profiles for predicting incident AD and dementia, on average 8 years before diagnosis (range: 1-11 years). Because real-world risk factors are structured questionnaire data, we translate them into clinically interpretable narratives compatible with pretrained vision-language models (VLMs). We further propose a group-aware contrastive learning (GACL) strategy that clusters patients with similar retinal morphometry and risk factors as positive pairs, strengthening multimodal alignment. This unified representation learning framework substantially outperforms state-of-the-art retinal imaging models paired with clinical text encoders, as well as general-purpose VLMs, demonstrating the value of jointly modeling retinal biomarkers and clinical risk factors. By providing a generalizable and noninvasive approach for early AD and dementia risk stratification, REVEAL has the potential to enable earlier intervention and improve preventive care at the population level.

Seowung Leem, Lin Gu, Chenyu You +2

J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, United2026 States · Research Institute of Electrical Communication, Tohoku University, Japan · Department of Applied Mathematics & Statistics, Stony Brook University, United StatesApr +1

Alzheimer's Disease Medical Imaging Cross-Modal Alignment Medical VLMs Alzheimer's Disease Classification Multimodal Contrastive Learning+1

Apr 18, 2026cs.LG

OC-Distill: Ontology-aware Contrastive Learning with Cross-Modal Distillation for ICU Risk Prediction

Early prediction of severe clinical deterioration and remaining length of stay can enable timely intervention and better resource allocation in high-acuity settings such as the ICU. This has driven the development of machine learning models that leverage continuous streams of vital signs and other physiological signals for real-time risk prediction. Despite their promise, existing methods have important limitations. Contrastive pretraining treats all patients as equally strong negatives, failing to capture clinically meaningful similarity between patients with related diagnoses. Meanwhile, downstream fine-tuning typically ignores complementary modalities such as clinical notes, which provide rich contextual information unavailable in physiological signals alone. To address these challenges, we propose OC-Distill, a two-stage framework that leverages multimodal supervision during training while requiring only vital signs at inference. In the first stage, we introduce an ontology-aware contrastive objective that exploits the ICD hierarchy to quantify patient similarity and learn clinically grounded representations. In the second stage, we fine-tune the pretrained encoder via cross-modal knowledge distillation, transferring complementary information from clinical notes into the model. Across multiple ICU prediction tasks on MIMIC, OC-Distill demonstrates improved label efficiency and achieves state-of-the-art performance among methods that use only vital signs at inference.

Zhongyuan Liang, Junhyung Jo, Hyang-Jung Lee +2

Computational Precision Health UC Berkeley, UCSF · Samsung Advanced Institute of Technology (SAIT) · Computational Precision Health UC Berkeley, UCSF[cs.LG]

Contrastive Learning Cross-Modal Knowledge Distillation Longitudinal EHR Modeling Clinical Risk Prediction

Apr 16, 2026cs.LG

Nationwide EHR-Based Chronic Rhinosinusitis Prediction Using Demographic-Stratified Models

Chronic rhinosinusitis (CRS) is a common heterogeneous inflammatory disorder that causes substantial morbidity and healthcare costs. CRS is difficult to identify early from routine encounters, as symptom presentations overlap with common conditions such as allergic rhinitis, and heterogeneous phenotypes further obscure risk patterns. Prior predictive studies often rely on single-institutional cohorts , which reduce population-level generalizability. To overcome this, we leveraged nationwide longitudinal EHR data from the \textit{All of Us} Research Program to predict CRS diagnosis using two years of pre-diagnostic history. To address extreme feature sparsity and dimensionality in coded EHR data, we implemented a hybrid feature-selection pipeline that combines prevalence-based statistical screening with model-based importance ranking, compressing approximately 110,000 candidate codes into 100 interpretable features. To capture demographic heterogeneity, we trained demographic stratified models across six adult sex and life-stage subgroups with subgroup-specific hyperparameter tuning. Our framework achieved an overall AUC of 0.8461, improving discrimination by 0.0168 over the best baseline. These results demonstrate that routinely collected EHR data may support population-representative CRS risk stratification and inform earlier triage and referral prioritization in primary care.

Sicong Chang, Yidan Shen, Justina Varghese +7

Electrical and Computer Engineering University of Houston Houston, USA · Otolaryngology Houston Methodist Hospital Houston, USA · Information Science Technology, University of Houston & Otolaryngology, Houston Methodist Hospital Houston, USA

Medical Diagnosis Clinical Prediction Longitudinal EHR Modeling Clinical Risk Prediction

Apr 16, 2026cs.CL

CURA: Clinical Uncertainty Risk Alignment for Language Model-Based Risk Prediction

Clinical language models (LMs) are increasingly applied to support clinical risk prediction from free-text notes, yet their uncertainty estimates often remain poorly calibrated and clinically unreliable. In this work, we propose Clinical Uncertainty Risk Alignment (CURA), a framework that aligns clinical LM-based risk estimates and uncertainty with both individual error likelihoods and cohort-level ambiguities. CURA first fine-tunes domain-specific clinical LMs to obtain task-adapted patient embeddings, and then performs uncertainty fine-tuning of a multi-head classifier using a bi-level uncertainty objective. Specifically, an individual-level calibration term aligns predictive uncertainty with each patient's likelihood of error, while a cohort-aware regularizer pulls risk estimates toward event rates in their local neighborhoods in the embedding space and places extra weight on ambiguous cohorts near the decision boundary. We further show that this cohort-aware term can be interpreted as a cross-entropy loss with neighborhood-informed soft labels, providing a label-smoothing view of our method. Extensive experiments on MIMIC-IV clinical risk prediction tasks across various clinical LMs show that CURA consistently improves calibration metrics without substantially compromising discrimination. Further analysis illustrates that CURA reduces overconfident false reassurance and yields more trustworthy uncertainty estimates for downstream clinical decision support.

Sizhe Wang, Ziqi Xu, Claire Najjuuko +2

Washington University in St. Louis

Language Model Calibration LLM Uncertainty Estimation Uncertainty Calibration Clinical Risk Prediction

Apr 16, 2026cs.LG

Predicting Post-Traumatic Epilepsy from Clinical Records using Large Language Model Embeddings

Objective: Post-traumatic epilepsy (PTE) is a debilitating neurological disorder that develops after traumatic brain injury (TBI). Early prediction of PTE remains challenging due to heterogeneous clinical data, limited positive cases, and reliance on resource-intensive neuroimaging data. We investigate whether routinely collected acute clinical records alone can support early PTE prediction using language model-based approaches. Methods: Using a curated subset of the TRACK-TBI cohort, we developed an automated PTE prediction framework that implements pretrained large language models (LLMs) as fixed feature extractors to encode clinical records. Tabular features, LLM-generated embeddings, and hybrid feature representations were evaluated using gradient-boosted tree classifiers under stratified cross-validation. Results: LLM embeddings achieved performance improvements by capturing contextual clinical information compared to using tabular features alone. The best performance was achieved by a modality-aware feature fusion strategy combining tabular features and LLM embeddings, achieving an AUC-ROC of 0.892 and AUPRC of 0.798. Acute post-traumatic seizures, injury severity, neurosurgical intervention, and ICU stay are key contributors to the predictive performance. Significance: These findings demonstrate that routine acute clinical records contain information suitable for early PTE risk prediction using LLM embeddings in conjunction with gradient-boosted tree classifiers. This approach represents a promising complement to imaging-based prediction.

Wenhui Cui, Nicholas Swingle, Anand A. Joshi +2

Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, CA, USA · Epilepsy Center, Cleveland Clinic Neurological Institute, OH, USA

Clinical Outcome Prediction Clinical Risk Prediction

Apr 16, 2026cs.LG

CSRA: Controlled Spectral Residual Augmentation for Robust Sepsis Prediction

Accurate prediction of future risk and disease progression in sepsis is clinically important for early warning and timely intervention in intensive care. However, short-window sepsis prediction remains challenging, because shorter observation windows provide limited historical evidence, whereas longer prediction horizons reduce the number of patient trajectories with valid future supervision. To address this problem, we propose CSRA, a Controlled Spectral Residual Augmentation framework for short-window multi-system ICU time series. CSRA first groups variables by clinical systems and extracts system-level and global representations. It then performs input-adaptive residual perturbation in the spectral domain to generate structured and clinically plausible trajectory variations. To improve augmentation stability and controllability, CSRA is trained end-to-end with the downstream predictor under a unified objective, together with anchor consistency loss and controller regularization. Experiments on a MIMIC-IV sepsis cohort across multiple downstream models show that CSRA is consistently competitive and often superior, reducing regression error by 10.2% in MSE and 3.7% in MAE over the non-augmentation baseline, while also yielding consistent gains on classification. CSRA further maintains more favorable performance under shorter observation windows, longer prediction horizons, and smaller training data scales, while also remaining effective on an external clinical dataset~(ZiGongICUinfection), indicating stronger robustness and generalizability in clinically constrained settings.

Honglin Guo, Rihao Chang, He Jiao +3

Tianjin University, Tianjin 300072, China · Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China · Tianjin Medical University General Hospital, Tianjin 300052, China

Clinical Prediction Time Series Data Augmentation Clinical Risk Prediction

Apr 6, 2026cs.LG

A Clinical Point Cloud Paradigm for In-Hospital Mortality Prediction from Multi-Level Incomplete Multimodal EHRs

Deep learning-based modeling of multimodal Electronic Health Records (EHRs) has become an important approach for clinical diagnosis and risk prediction. However, due to diverse clinical workflows and privacy constraints, raw EHRs are inherently multi-level incomplete, including irregular sampling, missing modalities, and sparse labels. These issues cause temporal misalignment, modality imbalance, and limited supervision. Most existing multimodal methods assume relatively complete data, and even methods designed for incompleteness usually address only one or two of these issues in isolation. As a result, they often rely on rigid temporal/modal alignment or discard incomplete data, which may distort raw clinical semantics. To address this problem, we propose HealthPoint (HP), a unified clinical point cloud paradigm for multi-level incomplete EHRs. HP represents heterogeneous clinical events as points in a continuous 4D space defined by content, time, modality, and case. To model interactions between arbitrary point pairs, we introduce a Low-Rank Relational Attention mechanism that efficiently captures high-order dependencies across these four dimensions. We further develop a hierarchical interaction and sampling strategy to balance fine-grained modeling and computational efficiency. Built on this framework, HP enables flexible event-level interaction and fine-grained self-supervision, supporting robust modality recovery and effective use of unlabeled data. Experiments on large-scale EHR datasets for risk prediction show that HP consistently achieves state-of-the-art performance and strong robustness under varying degrees of incompleteness.

Bohao Li, Tao Zou, Junchen Ye +2

Beihang University, Beijing, China · The Hong Kong Polytechnic University, Hong Kong, China

Electronic Health Records Clinical Risk Prediction Longitudinal EHR Modeling Missing-Modality Learning Point Cloud Learning

Apr 1, 2026cs.CL

CARE: Privacy-Compliant Agentic Reasoning with Evidence Discordance

Large language model (LLM) systems are increasingly used to support high-stakes decision-making, but they typically perform worse when the available evidence is internally inconsistent. Such a scenario exists in real-world healthcare settings, with patient-reported symptoms contradicting medical signs. To study this problem, we introduce MIMIC-DOS, a dataset for short-horizon organ dysfunction worsening prediction in the intensive care unit (ICU) setting. We derive this dataset from the widely recognized MIMIC-IV, a publicly available electronic health record dataset, and construct it exclusively from cases in which discordance between signs and symptoms exists. This setting poses a substantial challenge for existing LLM-based approaches, with single-pass LLMs and agentic pipelines often struggling to reconcile such conflicting signals. To address this problem, we propose CARE: a multi-stage privacy-compliant agentic reasoning framework in which a proprietary LLM provides guidance by generating structured categories and transitions without accessing sensitive patient data, while a local LLM uses these categories and transitions to support evidence acquisition and final decision-making. Empirically, under controlled retrospective evaluation on MIMIC-DOS, CARE achieves the best overall performance across key metrics among the evaluated LLMs and agentic workflows, showing that it can more robustly handle conflicting clinical evidence while preserving privacy.

Haochen Liu, Weien Li, Rui Song +6

University of Cambridge · McGill University · MBZUAI - Mohamed bin Zayed University of Artificial Intelligence +2

Privacy-Preserving Language Models Healthcare Clinical Decision-Making Multi-LLM Collaboration Clinical Risk Prediction

Mar 25, 2026cs.CV

CORA: Generalizable coronary artery disease assessment and risk stratification from coronary CT angiography using pathology-centric representation learning

Coronary artery disease, a leading cause of cardiovascular mortality worldwide, can be assessed non-invasively by coronary computed tomography angiography (CCTA). Although deep learning has advanced automated CCTA analysis, clinical translation remains constrained by the scarcity of expert-annotated data and by the spatial sparsity of coronary pathology, which occupies only a small fraction of each scan. Widely used label-free pretraining strategies, such as masked image modeling and contrastive learning, optimize for global anatomical reconstruction and tend to under-represent these tiny localized pathological features. Here we present CORA, an annotation-efficient model for comprehensive coronary artery disease assessment. Rather than reconstructing background anatomy, CORA learns from volumetric CCTA through a synthesis-driven self-supervised strategy: an anatomy-guided engine inserts diverse synthetic calcified and non-calcified lesions into unlabeled scans, reframing pretraining as an abnormality-detection task that biases representation learning toward clinically relevant disease features. We pretrained CORA on 10,138 unlabeled CCTA volumes and evaluated it across datasets from nine independent hospitals. Across plaque characterization, stenosis detection, and coronary artery segmentation, CORA consistently outperformed strong self-supervised pretraining baselines, with the largest gains on external multi-center data, indicating robust generalization under distributional shift. Coupling the imaging encoder with structured clinical variables further enabled near-term major adverse cardiac event (MACE) risk stratification. Our results show that pathology-centric, synthesis-driven pretraining is an effective and scalable strategy for annotation-efficient coronary artery disease assessment from CCTA.

Jinkui Hao, Gorkem Durak, Halil Ertugrul Aktas +4

Department of Radiology, Northwestern University, Chicago, IL, USA · Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA · Department of Cardiology, Northwestern University, Chicago, IL, USA +1

Synthetic Data Pretraining Coronary Angiography Medical Diagnosis Medical Image Anomaly Detection Medical Image Segmentation Coronary Artery Segmentation+2

Mar 9, 2026cs.LG

Data-Driven Priors for Uncertainty-Aware Risk Prediction of Clinical Deterioration using Multimodal Data

Safe predictions are a crucial requirement for integrating predictive models into clinical decision support systems. One approach to improving trustworthiness is to enable models to express uncertainty about individual predictions. However, current machine learning models frequently lack reliable uncertainty estimation, hindering real-world deployment. This limitation is particularly evident in multimodal settings, where models must effectively integrate heterogeneous information. In this work, we propose MedCertAIn, a predictive uncertainty framework that leverages multimodal clinical data to improve model performance and reliability for in-hospital mortality risk prediction as an indicator of patient deterioration. We design data-driven priors over neural network parameters using a hybrid strategy that considers cross-modal similarity in self-supervised latent representations and modality-specific data corruptions. We train and evaluate the models with such priors using clinical time-series and chest X-ray images from the publicly available datasets MIMIC-IV and MIMIC-CXR. Our results show that MedCertAIn achieves competitive predictive performance and substantial gains in selective prediction compared with the evaluated deterministic and stochastic baselines. These findings highlight the promise of data-driven priors in advancing robust, uncertainty-aware AI tools for high-stakes clinical applications. Our implementation is publicly available at: https://github.com/jlaitue/medcertain.

L. Julián Lechuga López, Tim G. J. Rudner, Farah E. Shamout

Tandon School of Engineering, New York University · New York University Abu Dhabi · University of Toronto

Bayesian Neural Networks Uncertainty Quantification Selective Prediction Mortality Prediction Clinical Risk Prediction Multimodal Learning

Feb 4, 2026cs.AI

AI Chatbot Suicide Risk Detection and Response: Human Validation Study of the Open-Source VERA-MH Safety Evaluation

Millions of people now use generative AI chatbots for psychological support. Despite their promise, the most pressing question in AI for mental health is whether these tools are safe. The field currently lacks a validated, automated benchmark for evaluating AI chatbot safety, particularly for users at risk of suicide. The Validation of Ethical and Responsible AI in Mental Health (VERA-MH) evaluation was recently proposed to address this need. This human validation study examined the alignment of VERA-MH safety ratings with expert clinician judgments. We simulated conversations between large language model (LLM)-based users spanning a range of suicide risk levels and disclosure styles and general-purpose AI chatbots. Licensed mental health clinicians from Spring Health independently rated chatbot safety using the VERA-MH scoring rubric. An LLM-based evaluator ("judge") applied the same rubric to the same conversations. We examined agreement among clinicians, between clinician consensus and the LLM judge, and across different judge LLMs. Clinicians also rated user-agent realism, suicide risk, and disclosure. Clinicians showed strong agreement in safety ratings (chance-corrected inter-rater reliability [IRR] = 0.77), establishing a reliable clinical consensus reference. The LLM judge was strongly aligned with this consensus (IRR = 0.81), and ratings were stable across judge models and repeated evaluations. Ratings of user-agent realism and fidelity to intended suicide risk and disclosure styles were mixed. These findings support the reliability of VERA-MH as an open-source, fully automated benchmark for evaluating AI chatbot suicide risk detection and response. Because these results reflect an earlier version of the benchmark, future work should validate updated versions, assess generalizability and robustness, and expand VERA-MH to additional domains of AI safety in mental health.

Kate H. Bentley, Luca Belli, Adam M. Chekroud +7

Spring Health · UC Berkeley · Yale University

Language Model Safety Evaluation Human-AI Agreement Mental Health Automated Evaluation AI Safety Clinical Risk Prediction

Nov 22, 2025stat.ML

Improving Forecasts of Suicide Attempts for Patients with Little Data

Ecological Momentary Assessment (EMA) studies provide real-time data on suicidal thoughts and behaviors, but forecasting suicide attempts remains challenging: attempts are rare, and the pathways patients take to them are heterogeneous. Here, we investigate a cohort of patients from an EMA study with recorded suicide-related events. We show that a single model fit to all patients forecasts poorly, while idiographic (per-patient) models show improvement but overfit for those with little data. Based on this result, one may hypothesize that patients should be partitioned into subgroups---this way, similar patients' data can be pooled together to improve forecasts. However, we show that grouping patients at random already improves forecasts, with performance increasing monotonically with the number of groups. Moreover, we show that grouping patients by demographics yields worse forecasts than random groupings. From these results, we hypothesize that patient similarity is continuous, rather than discrete, and must be inferred from the data. This motivated us to use Latent Variable Multiple Output Gaussian Processes (LVMOGPs), adapted to our data. Preliminary results show that, even without careful kernel design, LVMOGPs already match the strongest baseline models on most metrics, and their latent spaces yield a similarity between patients that we can inspect directly. Because the cohort is conditioned on the outcome and the splits are not temporal, we read these results as evidence that idiographic structure exists and can be recovered, not as deployable forecasting performance---an area for future work.

Genesis Hang, Annie Chen, Hope Neveux +2

Wellesley College · Harvard University

Latent Variable Models Gaussian Processes Clinical Prediction Suicide Risk Modeling Clinical Risk Prediction

Aug 23, 2025stat.ML

Neural Stochastic Differential Equations on Compact State Spaces: Theory, Methods, and Application to Suicide Risk Modeling

Ecological Momentary Assessment (EMA) studies enable the collection of high-frequency self-reports of suicidal thoughts and behaviors (STBs) via smartphones. Latent stochastic differential equations (SDEs) are a promising model class for EMA data, as it is irregularly sampled, noisy, and partially observed. But SDE-based models suffer from two key limitations. (a) These models often violate domain constraints, undermining scientific validity and clinical trust of the model. (b) Training is numerically unstable without ad hoc fixes (e.g. oversimplified dynamics) that are ill-suited for high-stakes applications. Here, we develop a novel class of expressive SDEs whose solutions are provably confined to a prescribed compact polyhedral state space, matching the domains of EMA data. In this work, (1) we show why chain-rule based constructions of SDEs on compact domains fail, theoretically and empirically; (2) we derive constraints on drift and diffusion for general and stationary SDEs so their solutions remain in the desired state space; and (3), we introduce a parameterization that maps arbitrary (neural or expert-given) dynamics into constraint-satisfying SDEs. On several real EMA datasets, including a large suicide-risk study, our parameterization improves forecasts and optimization dynamics over standard latent neural SDE baselines. These contributions pave the way for principled, trustworthy continuous-time models of suicide risk and other clinical time series and extend applications of SDE-based methods (e.g. diffusion models) to domains with hard state constraints.

Malinda Lu, Yue-Jane Liu, Matthew K. Nock +1

Wellesley College · Harvard University

Stochastic Differential Equations Latent Dynamics Modeling Mental Health Suicide Risk Modeling Clinical Risk Prediction

Aug 3, 2025cs.LG

GlaBoost: A Multimodal Structured Framework for Glaucoma Risk Stratification

Early and accurate glaucoma detection is critical to prevent irreversible vision loss, yet existing AI methods often rely on unimodal inputs and lack interpretability. We present GlaBoost, a multimodal gradient boosting framework that unifies three complementary signals for glaucoma risk prediction: fundus image embeddings from a pretrained convolutional encoder,free-text neuroretinal rim assessments encoded by a transformer-based language model, and structured ophthalmic biomarkers. These modalities are fused into a single representation and classified by an enhanced XGBoost model.On two real-world annotated datasets, GlaBoost consistently outperforms unimodal and generic multimodal baselines. Feature importance analysis highlights the cup-to-disc ratio, rim thinning, and the ISNT rule as the dominant predictors, yielding clinically consistent and interpretable decisions. GlaBoost offers a transparent and scalable foundation for multimodal decision support in ophthalmology.

Cheng Huang, Zeyu Han, Weizheng Xie +4

Department of Computer Science, Southern Methodist University, Dallas, TX 75205, USA · Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX 75390, USA · High Performance Computing Program, National Aeronautics and Space Administration, Washington, DC 20546, USA

Multimodal Fusion Clinical Risk Prediction

Dec 27, 2024cs.LG

Stroke Prediction using Clinical and Social Features in Machine Learning

Every year in the United States, 800,000 individuals suffer a stroke - one person every 40 seconds, with a death occurring every four minutes. While individual factors vary, certain predictors are more prevalent in determining stroke risk. As strokes are the second leading cause of death and disability worldwide, predicting stroke likelihood based on lifestyle factors is crucial. Showing individuals their stroke risk could motivate lifestyle changes, and machine learning offers solutions to this prediction challenge. Neural networks excel at predicting outcomes based on training features like lifestyle factors, however, they're not the only option. Logistic regression models can also effectively compute the likelihood of binary outcomes based on independent variables, making them well-suited for stroke prediction. This analysis will compare both neural networks (dense and convolutional) and logistic regression models for stroke prediction, examining their pros, cons, and differences to develop the most effective predictor that minimizes false negatives.

Aidan Chadha

Virginia Tech Blacksburg, VA

Multilayer Perceptrons Logistic Regression Clinical Risk Prediction

Mar 18, 2024cs.LG

Narrative Feature or Structured Feature? A Study of Large Language Models to Identify Cancer Patients at Risk of Heart Failure

Cancer treatments are known to introduce cardiotoxicity, negatively impacting outcomes and survivorship. Identifying cancer patients at risk of heart failure (HF) is critical to improving cancer treatment outcomes and safety. This study examined machine learning (ML) models to identify cancer patients at risk of HF using electronic health records (EHRs), including traditional ML, Time-Aware long short-term memory (T-LSTM), and large language models (LLMs) using novel narrative features derived from the structured medical codes. We identified a cancer cohort of 12,806 patients from the University of Florida Health, diagnosed with lung, breast, and colorectal cancers, among which 1,602 individuals developed HF after cancer. The LLM, GatorTron-3.9B, achieved the best F1 scores, outperforming the traditional support vector machines by 39%, the T-LSTM deep learning model by 7%, and a widely used transformer model, BERT, by 5.6%. The analysis shows that the proposed narrative features remarkably increased feature density and improved performance.

Ziyi Chen, Mengyuan Zhang, Mustafa Mohammed Ahmed +4

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA · Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA · Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA

Healthcare Oncology Longitudinal EHR Modeling Medical LLMs Clinical Risk Prediction

Nov 9, 2021cs.LG

Subtyping patients with chronic disease using longitudinal BMI patterns

Obesity is a major health problem, increasing the risk of various major chronic diseases, such as diabetes, cancer, and stroke. While the role of obesity identified by cross-sectional BMI recordings has been heavily studied, the role of BMI trajectories is much less explored. In this study, we use a machine-learning approach to subtype individuals' risk of developing 18 major chronic diseases by using their BMI trajectories extracted from a large and geographically diverse EHR dataset capturing the health status of around two million individuals for a period of six years. We define nine new interpretable and evidence-based variables based on the BMI trajectories to cluster the patients into subgroups using the k-means clustering method. We thoroughly review each cluster's characteristics in terms of demographic, socioeconomic, and physiological measurement variables to specify the distinct properties of the patients in the clusters. In our experiments, the direct relationship of obesity with diabetes, hypertension, Alzheimer's, and dementia has been re-established and distinct clusters with specific characteristics for several of the chronic diseases have been found to be conforming or complementary to the existing body of knowledge.

Md Mozaharul Mottalib, Jessica C Jones-Smith, Bethany Sheridan +1

Clinical Risk Prediction

Date pendingcs.LG

In-Hospital Stroke Risk-State Classification from PPG-Derived Hemodynamic Features

The scarcity of temporally aligned pre-event physiological data limits the study of stroke risk states before documented clinical recognition. We focus on patients who experienced stroke during hospitalization while undergoing continuous monitoring, enabling retrospective analysis of pre-anchor photoplethysmography (PPG). Using MIMIC-III and MC-MED, an LLM-assisted pipeline generated candidate stroke anchors from unstructured notes. All retained anchors underwent physician adjudication, and a stratified 100-case double-review audit showed 95.0% candidate-to-adjudicated agreement within +/-15 min. We identified 176 MIMIC-III patients and 154 MC-MED patients with eligible synchronized pre-anchor PPG. A fixed 17-channel hemodynamic representation and ResNet-1D classifier were evaluated using patient-level five-fold internal validation and frozen external testing. At validation-selected operating points, F1-scores were 0.7956, 0.8759, and 0.9406 for 4-, 5-, and 6-hour horizons in MIMIC-III and 0.9256, 0.9595, and 0.9888 in MC-MED; the corresponding threshold-free AUCs ranged from 0.6124 to 0.7079. The PPG model achieved higher F1 than four non-waveform clinical and structured-EHR comparators in all six cohort-horizon settings. On high-risk non-stroke controls, window-level false-positive rates ranged from 0.1371 to 0.2938 and decreased to 0.0183-0.1739 after persistence aggregation. These retrospective findings support measurable pre-anchor PPG structure, but do not establish biological stroke onset, a calibrated bedside alarm, or a clinically validated prediction lead time.

Jiaming Liu, Cheng Ding, Jian Wu +2

College of Artificial Intelligence, Nanjing University of Aeronautics and Astronautics, China · State Key Laboratory of Transvascular Implantation Devices and TIDRI, Hangzhou 310009, China · Zhejiang Key Laboratory of Medical Imaging Artificial Intelligence, Hangzhou 310058, China +1

Photoplethysmography Clinical Risk Prediction

Date pendingcs.CL

Expert-Level Crisis Detection in Mental Health Conversations

Real-world crisis intervention is inherently conversational, yet existing research largely focuses on static texts. When applied to multi-turn dialogues, current models exhibit significant performance degradation, struggling to track risk signals that emerge as context evolves. To address this gap, we introduce CRADLE-Dialogue, a clinician-annotated benchmark for turn-level crisis detection in conversational settings. The dataset features 600 dialogues with multi-label annotations across clinically grounded risks, including suicide ideation, self-harm, and child abuse, distinguishing past from ongoing risk. We further propose an Alert-Confirm evaluation protocol that distinguishes early warning signals (Alert) from turns where a specific crisis becomes explicitly identifiable (Confirm), reflecting the clinical need to intervene before risk becomes explicit. Experiments show that identifying when risk emerges is much harder than recognizing that it exists: models achieve only mid-40% to high-60% Micro F1. Additionally, we release a synthetic training corpus and a 32B-parameter model that substantially outperforms existing open-source models and achieves competitive or superior results against proprietary models across turn-level, dialogue-level, and confirm-only evaluation settings.

Grace Byun, Abigail Lott, Rebecca Lipschutz +3

Department of Computer Science, Emory University · Department of Psychiatry and Behavioral Sciences, Emory University

Mental Health Suicide Risk Modeling Clinical Language Model Evaluation Clinical Risk Prediction