Multimodal Forecasting of Sparse Intraoperative Hypotension Events Powered by Language Model
This work addresses a critical clinical problem for anesthesiologists by improving prediction of hypotension during surgery, though it is incremental as it builds on existing multimodal and language model approaches.
The paper tackles the problem of predicting sparse intraoperative hypotension events by proposing IOHFuseLM, a multimodal language model framework that integrates static and dynamic patient data, and it outperforms established baselines in accurately identifying these events on two intraoperative datasets.
Intraoperative hypotension (IOH) frequently occurs under general anesthesia and is strongly linked to adverse outcomes such as myocardial injury and increased mortality. Despite its significance, IOH prediction is hindered by event sparsity and the challenge of integrating static and dynamic data across diverse patients. In this paper, we propose \textbf{IOHFuseLM}, a multimodal language model framework. To accurately identify and differentiate sparse hypotensive events, we leverage a two-stage training strategy. The first stage involves domain adaptive pretraining on IOH physiological time series augmented through diffusion methods, thereby enhancing the model sensitivity to patterns associated with hypotension. Subsequently, task fine-tuning is performed on the original clinical dataset to further enhance the ability to distinguish normotensive from hypotensive states. To enable multimodal fusion for each patient, we align structured clinical descriptions with the corresponding physiological time series at the token level. Such alignment enables the model to capture individualized temporal patterns alongside their corresponding clinical semantics. In addition, we convert static patient attributes into structured text to enrich personalized information. Experimental evaluations on two intraoperative datasets demonstrate that IOHFuseLM outperforms established baselines in accurately identifying IOH events, highlighting its applicability in clinical decision support scenarios. Our code is publicly available to promote reproducibility at https://github.com/zjt-gpu/IOHFuseLM.