Maryam Pishgar

Negin Ashrafi, Armin Abdollahi, Jiahong Zhang et al.

Heart failure affects millions of people worldwide, significantly reducing quality of life and leading to high mortality rates. Despite extensive research, the relationship between heart failure and mortality rates among ICU patients is not fully understood, indicating the need for more accurate prediction models. This study analyzed data from 1,177 patients over 18 years old from the MIMIC-III database, identified using ICD-9 codes. Preprocessing steps included handling missing data, removing duplicates, treating skewness, and using oversampling techniques to address data imbalances. Through rigorous feature selection using Variance Inflation Factor (VIF), expert clinical input, and ablation studies, 46 key features were identified to enhance model performance. Our analysis compared several machine learning models, including Logistic Regression, Support Vector Machine (SVM), Random Forest, LightGBM, and XGBoost. XGBoost emerged as the superior model, achieving a test AUC-ROC of 0.9228 (95\% CI 0.8748 - 0.9613), significantly outperforming our previous work (AUC-ROC of 0.8766) and the best results reported in existing literature (AUC-ROC of 0.824). The improved model's success is attributed to advanced feature selection methods, robust preprocessing techniques, and comprehensive hyperparameter optimization through Grid-Search. SHAP analysis and feature importance evaluations based on XGBoost highlighted key variables like leucocyte count and RDW, providing valuable insights into the clinical factors influencing mortality risk. This framework offers significant support for clinicians, enabling them to identify high-risk ICU heart failure patients and improve patient outcomes through timely and informed interventions.

Negin Ashrafi, Armin Abdollahi, Greg Placencia et al.

Predicting critical health outcomes such as patient mortality and hospital readmission is essential for improving survivability. However, healthcare datasets have many concurrences that create complexities, leading to poor predictions. Consequently, pre-processing the data is crucial to improve its quality. In this study, we use an existing pre-processing algorithm, concatenation, to improve data quality by decreasing the complexity of datasets. Sixteen healthcare datasets were extracted from two databases - MIMIC III and University of Illinois Hospital - converted to the event logs, they were then fed into the concatenation algorithm. The pre-processed event logs were then fed to the Split Miner (SM) algorithm to produce a process model. Process model quality was evaluated before and after concatenation using the following metrics: fitness, precision, F-Measure, and complexity. The pre-processed event logs were also used as inputs to the Decay Replay Mining (DREAM) algorithm to predict critical outcomes. We compared predicted results before and after applying the concatenation algorithm using Area Under the Curve (AUC) and Confidence Intervals (CI). Results indicated that the concatenation algorithm improved the quality of the process models and predictions of the critical health outcomes.

Armin Abdollahi, Negin Ashrafi, Maryam Pishgar

Background: Stroke is second-leading cause of disability and death among adults. Approximately 17 million people suffer from a stroke annually, with about 85% being ischemic strokes. Predicting mortality of ischemic stroke patients in intensive care unit (ICU) is crucial for optimizing treatment strategies, allocating resources, and improving survival rates. Methods: We acquired data on ICU ischemic stroke patients from MIMIC-IV database, including diagnoses, vital signs, laboratory tests, medications, procedures, treatments, and clinical notes. Stroke patients were randomly divided into training (70%, n=2441), test (15%, n=523), and validation (15%, n=523) sets. To address data imbalances, we applied Synthetic Minority Over-sampling Technique (SMOTE). We selected 30 features for model development, significantly reducing feature number from 1095 used in the best study. We developed a deep learning model to assess mortality risk and implemented several baseline machine learning models for comparison. Results: XGB-DL model, combining XGBoost for feature selection and deep learning, effectively minimized false positives. Model's AUROC improved from 0.865 (95% CI: 0.821 - 0.905) on first day to 0.903 (95% CI: 0.868 - 0.936) by fourth day using data from 3,646 ICU mortality patients in the MIMIC-IV database with 0.945 AUROC (95% CI: 0.944 - 0.947) during training. Although other ML models also performed well in terms of AUROC, we chose Deep Learning for its higher specificity. Conclusions: Through enhanced feature selection and data cleaning, proposed model demonstrates a 13% AUROC improvement compared to existing models while reducing feature number from 1095 in previous studies to 30.

Arseniy Shumilov, Yueting Zhu, Negin Ashrafi et al.

Sepsis is a severe condition responsible for many deaths in the United States and worldwide, making accurate prediction of outcomes crucial for timely and effective treatment. Previous studies employing machine learning faced limitations in feature selection and model interpretability, reducing their clinical applicability. This research aimed to develop an interpretable and accurate machine learning model to predict in-hospital sepsis mortality, addressing these gaps. Using ICU patient records from the MIMIC-III database, we extracted relevant data through a combination of literature review, clinical input refinement, and Random Forest-based feature selection, identifying the top 35 features. Data preprocessing included cleaning, imputation, standardization, and applying the Synthetic Minority Over-sampling Technique (SMOTE) to address class imbalance, resulting in a dataset of 4,683 patients with 17,429 admissions. Five models-Random Forest, Gradient Boosting, Logistic Regression, Support Vector Machine, and K-Nearest Neighbor-were developed and evaluated. The Random Forest model demonstrated the best performance, achieving an accuracy of 0.90, AUROC of 0.97, precision of 0.93, recall of 0.91, and F1-score of 0.92. These findings underscore the potential of data-driven machine learning approaches to improve critical care, offering clinicians a powerful tool for predicting in-hospital sepsis mortality and enhancing patient outcomes.

Negin Ashrafi, Armin Abdollahi, Maryam Pishgar

Background: Ventilator-associated pneumonia (VAP) in traumatic brain injury (TBI) patients poses a significant mortality risk and imposes a considerable financial burden on patients and healthcare systems. Timely detection and prognostication of VAP in TBI patients are crucial to improve patient outcomes and alleviate the strain on healthcare resources. Methods: We implemented six machine learning models using the MIMIC-III database. Our methodology included preprocessing steps, such as feature selection with CatBoost and expert opinion, addressing class imbalance with the Synthetic Minority Oversampling Technique (SMOTE), and rigorous model tuning through 5-fold cross-validation to optimize hyperparameters. Key models evaluated included SVM, Logistic Regression, Random Forest, XGBoost, ANN, and AdaBoost. Additionally, we conducted SHAP analysis to determine feature importance and performed an ablation study to assess feature impacts on model performance. Results: XGBoost outperformed the baseline models and the best existing literature. We used metrics, including AUC, Accuracy, Specificity, Sensitivity, F1 Score, PPV, and NPV. XGBoost demonstrated the highest performance with an AUC of 0.940 and an Accuracy of 0.875, which are 23.4% and 23.5% higher than the best results in the existing literature, with an AUC of 0.706 and an Accuracy of 0.640, respectively. This enhanced performance underscores the models' effectiveness in clinical settings. Conclusions: This study enhances the predictive modeling of VAP in TBI patients, improving early detection and intervention potential. Refined feature selection and advanced ensemble techniques significantly boosted model accuracy and reliability, offering promising directions for future clinical applications and medical diagnostics research.

Shuheng Chen, Junyi Fan, Elham Pishgar et al.

Background: Sepsis-Associated Acute Kidney Injury (SA-AKI) leads to high mortality in intensive care. This study develops machine learning models using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to predict Intensive Care Unit (ICU) mortality in SA-AKI patients. External validation is conducted using the eICU Collaborative Research Database. Methods: For 9,474 identified SA-AKI patients in MIMIC-IV, key features like lab results, vital signs, and comorbidities were selected using Variance Inflation Factor (VIF), Recursive Feature Elimination (RFE), and expert input, narrowing to 24 predictive variables. An Extreme Gradient Boosting (XGBoost) model was built for in-hospital mortality prediction, with hyperparameters optimized using GridSearch. Model interpretability was enhanced with SHapley Additive exPlanations (SHAP) and Local Interpretable Model-agnostic Explanations (LIME). External validation was conducted using the eICU database. Results: The proposed XGBoost model achieved an internal Area Under the Receiver Operating Characteristic curve (AUROC) of 0.878 (95% Confidence Interval: 0.859-0.897). SHAP identified Sequential Organ Failure Assessment (SOFA), serum lactate, and respiratory rate as key mortality predictors. LIME highlighted serum lactate, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, total urine output, and serum calcium as critical features. Conclusions: The integration of advanced techniques with the XGBoost algorithm yielded a highly accurate and interpretable model for predicting SA-AKI mortality across diverse populations. It supports early identification of high-risk patients, enhancing clinical decision-making in intensive care. Future work needs to focus on enhancing adaptability, versatility, and real-world applications.

Aleyeh Roknaldin, Zehao Zhang, Jiayuan Xu et al.

Sepsis is a severe condition that causes the body to respond incorrectly to an infection. This reaction can subsequently cause organ failure, a major one being acute kidney injury (AKI). For septic patients, approximately 50% develop AKI, with a mortality rate above 40%. Creating models that can accurately predict AKI based on specific qualities of septic patients is crucial for early detection and intervention. Using medical data from septic patients during intensive care unit (ICU) admission from the Medical Information Mart for Intensive Care 3 (MIMIC-III) database, we extracted 3301 patients with sepsis, with 73% of patients developing AKI. The data was randomly divided into a training set (n = 1980, 40%), a test set (n = 661, 10%), and a validation set (n = 660, 50%). The proposed model was logistic regression, and it was compared against five baseline models: XGBoost, K Nearest Neighbors (KNN), Support Vector Machines (SVM), Random Forest (RF), and LightGBM. Area Under the Curve (AUC), Accuracy, F1-Score, and Recall were calculated for each model. After analysis, we were able to select 23 features to include in our model, the top features being urine output, maximum bilirubin, minimum bilirubin, weight, maximum blood urea nitrogen, and minimum estimated glomerular filtration rate. The logistic regression model performed the best, achieving an AUC score of 0.887 (95% CI: [0.861-0.915]), an accuracy of 0.817, an F1 score of 0.866, a recall score of 0.827, and a Brier score of 0.13. Compared to the best existing literature in this field, our model achieved an 8.57% improvement in AUC while using 13 fewer variables, showcasing its effectiveness in determining AKI in septic patients. While the features selected for predicting AKI in septic patients are similar to previous literature, the top features that influenced our model's performance differ.

Junyi Fan, Shuheng Chen, Li Sun et al.

Aplastic anemia is a rare, life-threatening hematologic disorder characterized by pancytopenia and bone marrow failure. ICU admission in these patients often signals critical complications or disease progression, making early risk assessment crucial for clinical decision-making and resource allocation. In this study, we used the MIMIC-IV database to identify ICU patients diagnosed with aplastic anemia and extracted clinical features from five domains: demographics, synthetic indicators, laboratory results, comorbidities, and medications. Over 400 variables were reduced to seven key predictors through machine learning-based feature selection. Logistic regression and Cox regression models were constructed to predict 7-, 14-, and 28-day mortality, and their performance was evaluated using AUROC. External validation was conducted using the eICU Collaborative Research Database to assess model generalizability. Among 1,662 included patients, the logistic regression model demonstrated superior performance, with AUROC values of 0.8227, 0.8311, and 0.8298 for 7-, 14-, and 28-day mortality, respectively, compared to the Cox model. External validation yielded AUROCs of 0.7391, 0.7119, and 0.7093. Interactive nomograms were developed based on the logistic regression model to visually estimate individual patient risk. In conclusion, we identified a concise set of seven predictors, led by APS III, to build validated and generalizable nomograms that accurately estimate short-term mortality in ICU patients with aplastic anemia. These tools may aid clinicians in personalized risk stratification and decision-making at the point of care.

Shuheng Chen, Junyi Fan, Armin Abdollahi et al.

Intracerebral hemorrhage (ICH) is a life-risking condition characterized by bleeding within the brain parenchyma. ICU readmission in ICH patients is a critical outcome, reflecting both clinical severity and resource utilization. Accurate prediction of ICU readmission risk is crucial for guiding clinical decision-making and optimizing healthcare resources. This study utilized the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) databases, which contain comprehensive clinical and demographic data on ICU patients. Patients with ICH were identified from both databases. Various clinical, laboratory, and demographic features were extracted for analysis based on both overview literature and experts' opinions. Preprocessing methods like imputing and sampling were applied to improve the performance of our models. Machine learning techniques, such as Artificial Neural Network (ANN), XGBoost, and Random Forest, were employed to develop predictive models for ICU readmission risk. Model performance was evaluated using metrics such as AUROC, accuracy, sensitivity, and specificity. The developed models demonstrated robust predictive accuracy for ICU readmission in ICH patients, with key predictors including demographic information, clinical parameters, and laboratory measurements. Our study provides a predictive framework for ICU readmission risk in ICH patients, which can aid in clinical decision-making and improve resource allocation in intensive care settings.

Junyi Fan, Li Sun, Shuheng Chen et al.

Background: Vancomycin, a key antibiotic for severe Gram-positive infections in ICUs, poses a high nephrotoxicity risk. Early prediction of kidney injury in critically ill patients is challenging. This study aimed to develop a machine learning model to predict vancomycin-related creatinine elevation using routine ICU data. Methods: We analyzed 10,288 ICU patients (aged 18-80) from the MIMIC-IV database who received vancomycin. Kidney injury was defined by KDIGO criteria (creatinine rise >=0.3 mg/dL within 48h or >=50% within 7d). Features were selected via SelectKBest (top 30) and Random Forest ranking (final 15). Six algorithms were tested with 5-fold cross-validation. Interpretability was evaluated using SHAP, Accumulated Local Effects (ALE), and Bayesian posterior sampling. Results: Of 10,288 patients, 2,903 (28.2%) developed creatinine elevation. CatBoost performed best (AUROC 0.818 [95% CI: 0.801-0.834], sensitivity 0.800, specificity 0.681, negative predictive value 0.900). Key predictors were phosphate, total bilirubin, magnesium, Charlson index, and APSIII. SHAP confirmed phosphate as a major risk factor. ALE showed dose-response patterns. Bayesian analysis estimated mean risk 60.5% (95% credible interval: 16.8-89.4%) in high-risk cases. Conclusions: This machine learning model predicts vancomycin-associated creatinine elevation from routine ICU data with strong accuracy and interpretability, enabling early risk detection and supporting timely interventions in critical care.

Li Sun, Shuheng Chen, Yong Si et al.

Background: Patients with both diabetes mellitus (DM) and atrial fibrillation (AF) face elevated mortality in intensive care units (ICUs), yet models targeting this high-risk group remain limited. Objective: To develop an interpretable machine learning (ML) model predicting 28-day mortality in ICU patients with concurrent DM and AF using early-phase clinical data. Methods: A retrospective cohort of 1,535 adult ICU patients with DM and AF was extracted from the MIMIC-IV database. Data preprocessing involved median/mode imputation, z-score normalization, and early temporal feature engineering. A two-step feature selection pipeline-univariate filtering (ANOVA F-test) and Random Forest-based multivariate ranking-yielded 19 interpretable features. Seven ML models were trained with stratified 5-fold cross-validation and SMOTE oversampling. Interpretability was assessed via ablation and Accumulated Local Effects (ALE) analysis. Results: Logistic regression achieved the best performance (AUROC: 0.825; 95% CI: 0.779-0.867), surpassing more complex models. Key predictors included RAS, age, bilirubin, and extubation. ALE plots showed intuitive, non-linear effects such as age-related risk acceleration and bilirubin thresholds. Conclusion: This interpretable ML model offers accurate risk prediction and clinical insights for early ICU triage in patients with DM and AF.

Tinghuan Li, Shuheng Chen, Junyi Fan et al.

Postoperative stroke remains a critical complication in elderly surgical intensive care unit (SICU) patients, contributing to prolonged hospitalization, elevated healthcare costs, and increased mortality. Accurate early risk stratification is essential to enable timely intervention and improve clinical outcomes. We constructed a combined cohort of 19,085 elderly SICU admissions from the MIMIC-III and MIMIC-IV databases and developed an interpretable machine learning (ML) framework to predict in-hospital stroke using clinical data from the first 24 hours of Intensive Care Unit (ICU) stay. The preprocessing pipeline included removal of high-missingness features, iterative Singular Value Decomposition (SVD) imputation, z-score normalization, one-hot encoding, and class imbalance correction via the Adaptive Synthetic Sampling (ADASYN) algorithm. A two-stage feature selection process-combining Recursive Feature Elimination with Cross-Validation (RFECV) and SHapley Additive exPlanations (SHAP)-reduced the initial 80 variables to 20 clinically informative predictors. Among eight ML models evaluated, CatBoost achieved the best performance with an AUROC of 0.8868 (95% CI: 0.8802--0.8937). SHAP analysis and ablation studies identified prior cerebrovascular disease, serum creatinine, and systolic blood pressure as the most influential risk factors. Our results highlight the potential of interpretable ML approaches to support early detection of postoperative stroke and inform decision-making in perioperative critical care.

Haonan Pan, Shuheng Chen, Elham Pishgar et al.

Coronary artery disease remains one of the leading causes of mortality globally. Despite advances in revascularization treatments like PCI and CABG, postoperative stroke is inevitable. This study aims to develop and evaluate a sophisticated machine learning prediction model to assess postoperative stroke risk in coronary revascularization patients.This research employed data from the MIMIC-IV database, consisting of a cohort of 7023 individuals. Study data included clinical, laboratory, and comorbidity variables. To reduce multicollinearity, variables with over 30% missing values and features with a correlation coefficient larger than 0.9 were deleted. The dataset has 70% training and 30% test. The Random Forest technique interpolated residual dataset missing values. Numerical values were normalized, whereas categorical variables were one-hot encoded. LASSO regularization selected features, and grid search found model hyperparameters. Finally, Logistic Regression, XGBoost, SVM, and CatBoost were employed for predictive modeling, and SHAP analysis assessed stroke risk for each variable. AUC of 0.855 (0.829-0.878) showed that SVM model outperformed logistic regression and CatBoost models in prior research. SHAP research showed that the Charlson Comorbidity Index (CCI), diabetes, chronic kidney disease, and heart failure are significant prognostic factors for postoperative stroke. This study shows that improved machine learning reduces overfitting and improves model predictive accuracy. Models using the CCI alone cannot predict postoperative stroke risk as accurately as those using independent comorbidity variables. The suggested technique provides a more thorough and individualized risk assessment by encompassing a wider range of clinically relevant characteristics, making it a better reference for preoperative risk assessments and targeted intervention.

Houji Jin, Negin Ashrafi, Kamiar Alaei et al.

Sepsis is a major cause of ICU mortality, where early recognition and effective interventions are essential for improving patient outcomes. However, the vasoactive-inotropic score (VIS) varies dynamically with a patient's hemodynamic status, complicated by irregular medication patterns, missing data, and confounders, making sepsis prediction challenging. To address this, we propose a novel Teacher-Student multitask framework with self-supervised VIS pretraining via a Masked Autoencoder (MAE). The teacher model performs mortality classification and severity-score regression, while the student distills robust time-series representations, enhancing adaptation to heterogeneous VIS data. Compared to LSTM-based methods, our approach achieves an AUROC of 0.82 on MIMIC-IV 3.0 (9,476 patients), outperforming the baseline (0.74). SHAP analysis revealed that SOFA score (0.147) had the greatest impact on ICU mortality, followed by LODS (0.033), single marital status (0.031), and Medicaid insurance (0.023), highlighting the role of sociodemographic factors. SAPSII (0.020) also contributed significantly. These findings suggest that both clinical and social factors should be considered in ICU decision-making. Our novel multitask and distillation strategies enable earlier identification of high-risk patients, improving prediction accuracy and disease management, offering new tools for ICU decision support.

Yuhai Wang, Maryam Pishgar

Aerial-Ground Person Re-identification (AGPReID) holds significant practical value but faces unique challenges due to pronounced variations in viewing angles, lighting conditions, and background interference. Traditional methods, often involving a global analysis of the entire image, frequently lead to inefficiencies and susceptibility to irrelevant data. In this paper, we propose a novel Dynamic Token Selective Transformer (DTST) tailored for AGPReID, which dynamically selects pivotal tokens to concentrate on pertinent regions. Specifically, we segment the input image into multiple tokens, with each token representing a unique region or feature within the image. Using a Top-k strategy, we extract the k most significant tokens that contain vital information essential for identity recognition. Subsequently, an attention mechanism is employed to discern interrelations among diverse tokens, thereby enhancing the representation of identity features. Extensive experiments on benchmark datasets showcases the superiority of our method over existing works. Notably, on the CARGO dataset, our proposed method gains 1.18% mAP improvements when compared to the second place. In addition, we comprehensively analyze the impact of different numbers of tokens, token insertion positions, and numbers of heads on model performance.

Junyi Fan, Li Sun, Negin Ashrafi et al.

Nursing documentation in intensive care units (ICUs) provides essential clinical intelligence but often suffers from inconsistent terminology, informal styles, and lack of standardization, challenges that are particularly critical in heart failure care. This study applies Direct Preference Optimization (DPO) to adapt Mistral-7B, a locally deployable language model, using 8,838 heart failure nursing notes from the MIMIC-III database and 21,210 preference pairs derived from expert-verified GPT outputs, model generations, and original notes. Evaluation across BLEU, ROUGE, BERTScore, Perplexity, and expert qualitative assessments demonstrates that DPO markedly enhances documentation quality. Specifically, BLEU increased by 84% (0.173 to 0.318), BERTScore improved by 7.6% (0.828 to 0.891), and expert ratings rose across accuracy (+14.4 points), completeness (+14.5 points), logical consistency (+14.1 points), readability (+11.1 points), and structural clarity (+6.0 points). These results indicate that DPO can align lightweight clinical language models with expert standards, supporting privacy-preserving, AI-assisted documentation within electronic health record systems to reduce administrative burden and improve ICU patient safety.

Houji Jin, Negin Ashrafi, Armin Abdollahi et al.

The rapid growth of large language models (LLMs) has heightened the demand for accurate detection of AI-generated text, particularly in languages like Chinese, where subtle linguistic nuances pose significant challenges to current methods. In this study, we conduct a systematic comparison of encoder-based Transformers (Chinese BERT-large and RoBERTa-wwm-ext-large), a decoder-only LLM (Alibaba's Qwen2.5-7B/DeepSeek-R1-Distill-Qwen-7B fine-tuned via Low-Rank Adaptation, LoRA), and a FastText baseline using the publicly available dataset from the NLPCC 2025 Chinese AI-Generated Text Detection Task. Encoder models were fine-tuned using a novel prompt-based masked language modeling approach, while Qwen2.5-7B was adapted for classification with an instruction-format input and a lightweight classification head trained via LoRA. Experiments reveal that although encoder models nearly memorize training data, they suffer significant performance degradation under distribution shifts (RoBERTa: 76.3% test accuracy; BERT: 79.3%). FastText demonstrates surprising lexical robustness (83.5% accuracy) yet lacks deeper semantic understanding. In contrast, the LoRA-adapted Qwen2.5-7B achieves 95.94% test accuracy with balanced precision-recall metrics, indicating superior generalization and resilience to dataset-specific artifacts. These findings underscore the efficacy of decoder-based LLMs with parameter-efficient fine-tuning for robust Chinese AI-generated text detection. Future work will explore next-generation Qwen3 models, distilled variants, and ensemble strategies to enhance cross-domain robustness further.

Li Sun, Shuheng Chen, Junyi Fan et al.

Background: Cirrhosis is a progressive liver disease with high mortality and frequent complications, notably acute kidney injury (AKI), which occurs in up to 50% of hospitalized patients and worsens outcomes. AKI stems from complex hemodynamic, inflammatory, and metabolic changes, making early detection essential. Many predictive tools lack accuracy, interpretability, and alignment with intensive care unit (ICU) workflows. This study developed an interpretable machine learning model for early AKI prediction in critically ill patients with cirrhosis. Methods: We conducted a retrospective analysis of the MIMIC-IV v2.2 database, identifying 1240 adult ICU patients with cirrhosis and excluding those with ICU stays under 48 hours or missing key data. Laboratory and physiological variables from the first 48 hours were extracted. The pipeline included preprocessing, missingness filtering, LASSO feature selection, and SMOTE class balancing. Six algorithms-LightGBM, CatBoost, XGBoost, logistic regression, naive Bayes, and neural networks-were trained and evaluated using AUROC, accuracy, F1-score, sensitivity, specificity, and predictive values. Results: LightGBM achieved the best performance (AUROC 0.808, 95% CI 0.741-0.856; accuracy 0.704; NPV 0.911). Key predictors included prolonged partial thromboplastin time, absence of outside-facility 20G placement, low pH, and altered pO2, consistent with known cirrhosis-AKI mechanisms and suggesting actionable targets. Conclusion: The LightGBM-based model enables accurate early AKI risk stratification in ICU patients with cirrhosis using routine clinical variables. Its high negative predictive value supports safe de-escalation for low-risk patients, and interpretability fosters clinician trust and targeted prevention. External validation and integration into electronic health record systems are warranted.

Yong Si, Junyi Fan, Li Sun et al.

Background: Hypertensive kidney disease (HKD) patients in intensive care units (ICUs) face high short-term mortality, but tailored risk prediction tools are lacking. Early identification of high-risk individuals is crucial for clinical decision-making. Methods: We developed a machine learning framework to predict 30-day in-hospital mortality among ICU patients with HKD using early clinical data from the MIMIC-IV v2.2 database. A cohort of 1,366 adults was curated with strict criteria, excluding malignancy cases. Eighteen clinical features-including vital signs, labs, comorbidities, and therapies-were selected via random forest importance and mutual information filtering. Several models were trained and compared with stratified five-fold cross-validation; CatBoost demonstrated the best performance. Results: CatBoost achieved an AUROC of 0.88 on the independent test set, with sensitivity of 0.811 and specificity of 0.798. SHAP values and Accumulated Local Effects (ALE) plots showed the model relied on meaningful predictors such as altered consciousness, vasopressor use, and coagulation status. Additionally, the DREAM algorithm was integrated to estimate patient-specific posterior risk distributions, allowing clinicians to assess both predicted mortality and its uncertainty. Conclusions: We present an interpretable machine learning pipeline for early, real-time risk assessment in ICU patients with HKD. By combining high predictive performance with uncertainty quantification, our model supports individualized triage and transparent clinical decisions. This approach shows promise for clinical deployment and merits external validation in broader critical care populations.

Antonios Alexos, Yu-Dai Tsai, Ian Domingo et al.

Creating controlled methods to simulate neurodegeneration in artificial intelligence (AI) is crucial for applications that emulate brain function decline and cognitive disorders. We use IQ tests performed by Large Language Models (LLMs) and, more specifically, the LLaMA 2 to introduce the concept of ``neural erosion." This deliberate erosion involves ablating synapses or neurons, or adding Gaussian noise during or after training, resulting in a controlled progressive decline in the LLMs' performance. We are able to describe the neurodegeneration in the IQ tests and show that the LLM first loses its mathematical abilities and then its linguistic abilities, while further losing its ability to understand the questions. To the best of our knowledge, this is the first work that models neurodegeneration with text data, compared to other works that operate in the computer vision domain. Finally, we draw similarities between our study and cognitive decline clinical studies involving test subjects. We find that with the application of neurodegenerative methods, LLMs lose abstract thinking abilities, followed by mathematical degradation, and ultimately, a loss in linguistic ability, responding to prompts incoherently. These findings are in accordance with human studies.

Maryam Pishgar, Martha Razo, Julian Theis et al.

Paralytic Ileus (PI) patients are at high risk of death when admitted to the Intensive care unit (ICU), with mortality as high as 40\%. There is minimal research concerning PI patient mortality prediction. There is a need for more accurate prediction modeling for ICU patients diagnosed with PI. This paper demonstrates performance improvements in predicting the mortality of ICU patients diagnosed with PI after 24 hours of being admitted. The proposed framework, PMPI(Process Mining Model to predict mortality of PI patients), is a modification of the work used for prediction of in-hospital mortality for ICU patients with diabetes. PMPI demonstrates similar if not better performance with an Area under the ROC Curve (AUC) score of 0.82 compared to the best results of the existing literature. PMPI uses patient medical history, the time related to the events, and demographic information for prediction. The PMPI prediction framework has the potential to help medical teams in making better decisions for treatment and care for ICU patients with PI to increase their life expectancy.

Maryam Pishgar, Fazle Karim, Somshubra Majumdar et al.

Vocal disorders have affected several patients all over the world. Due to the inherent difficulty of diagnosing vocal disorders without sophisticated equipment and trained personnel, a number of patients remain undiagnosed. To alleviate the monetary cost of diagnosis, there has been a recent growth in the use of data analysis to accurately detect and diagnose individuals for a fraction of the cost. We propose a cheap, efficient and accurate model to diagnose whether a patient suffers from one of three vocal disorders on the FEMH 2018 challenge.