Transparent Early ICU Mortality Prediction with Clinical Transformer and Per-Case Modality Attribution
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arXiv
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| Autori principali: | , , |
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| Natura: | Preprint |
| Pubblicazione: |
2025
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| _version_ | 1866917093853626368 |
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| author | Bakumenko, Alexander Hoelscher, Janine Smith, Hudson |
| author_facet | Bakumenko, Alexander Hoelscher, Janine Smith, Hudson |
| contents | Early identification of intensive care patients at risk of in-hospital mortality enables timely intervention and efficient resource allocation. Despite high predictive performance, existing machine learning approaches lack transparency and robustness, limiting clinical adoption. We present a lightweight, transparent multimodal ensemble that fuses physiological time-series measurements with unstructured clinical notes from the first 48 hours of an ICU stay. A logistic regression model combines predictions from two modality-specific models: a bidirectional LSTM for vitals and a finetuned ClinicalModernBERT transformer for notes. This traceable architecture allows for multilevel interpretability: feature attributions within each modality and direct per-case modality attributions quantifying how vitals and notes influence each decision. On the MIMIC-III benchmark, our late-fusion ensemble improves discrimination over the best single model (AUPRC 0.565 vs. 0.526; AUROC 0.891 vs. 0.876) while maintaining well-calibrated predictions. The system remains robust through a calibrated fallback when a modality is missing. These results demonstrate competitive performance with reliable, auditable risk estimates and transparent, predictable operation, which together are crucial for clinical use. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2511_15847 |
| institution | arXiv |
| publishDate | 2025 |
| record_format | arxiv |
| spellingShingle | Transparent Early ICU Mortality Prediction with Clinical Transformer and Per-Case Modality Attribution Bakumenko, Alexander Hoelscher, Janine Smith, Hudson Machine Learning Early identification of intensive care patients at risk of in-hospital mortality enables timely intervention and efficient resource allocation. Despite high predictive performance, existing machine learning approaches lack transparency and robustness, limiting clinical adoption. We present a lightweight, transparent multimodal ensemble that fuses physiological time-series measurements with unstructured clinical notes from the first 48 hours of an ICU stay. A logistic regression model combines predictions from two modality-specific models: a bidirectional LSTM for vitals and a finetuned ClinicalModernBERT transformer for notes. This traceable architecture allows for multilevel interpretability: feature attributions within each modality and direct per-case modality attributions quantifying how vitals and notes influence each decision. On the MIMIC-III benchmark, our late-fusion ensemble improves discrimination over the best single model (AUPRC 0.565 vs. 0.526; AUROC 0.891 vs. 0.876) while maintaining well-calibrated predictions. The system remains robust through a calibrated fallback when a modality is missing. These results demonstrate competitive performance with reliable, auditable risk estimates and transparent, predictable operation, which together are crucial for clinical use. |
| title | Transparent Early ICU Mortality Prediction with Clinical Transformer and Per-Case Modality Attribution |
| topic | Machine Learning |
| url | https://arxiv.org/abs/2511.15847 |