Development, multi-institutional external validation, and algorithmic audit of an artificial intelligence-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA) for patients undergoing radical prostatectomy: a retrospective cohort study

BackgroundIn the pediatric intensive care unit (PICU), quantifying illness severity can be guided by risk models to enable timely identification and appropriate intervention. Logistic regression models, including the pediatric index of mortality 2 (PIM-2) and pediatric risk of mortality III (PRISM-III), produce a mortality risk score using data that are routinely available at PICU admission. Artificial neural networks (ANNs) outperform regression models in some medical fields.ObjectiveIn light of this potential, we aim to examine ANN performance, compared to that of logistic regression, for mortality risk estimation in the PICU.MethodsThe analyzed data set included patients from North American PICUs whose discharge diagnostic codes indicated evidence of infection and included the data used for the PIM-2 and PRISM-III calculations and their corresponding scores. We stratified the data set into training and test sets, with approximately equal mortality rates, in an effort to replicate real-world data. Data preprocessing included imputing missing data through simple substitution and normalizing data into binary variables using PRISM-III thresholds. A 2-layer ANN model was built to predict pediatric mortality, along with a simple logistic regression model for comparison. Both models used the same features required by PIM-2 and PRISM-III. Alternative ANN models using single-layer or unnormalized data were also evaluated. Model performance was compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC) and their empirical 95% CIs.ResultsData from 102,945 patients (including 4068 deaths) were included in the analysis. The highest performing ANN (AUROC 0.871, 95% CI 0.862-0.880; AUPRC 0.372, 95% CI 0.345-0.396) that used normalized data performed better than PIM-2 (AUROC 0.805, 95% CI 0.801-0.816; AUPRC 0.234, 95% CI 0.213-0.255) and PRISM-III (AUROC 0.844, 95% CI 0.841-0.855; AUPRC 0.348, 95% CI 0.322-0.367). The performance of this ANN was also significantly better than that of the logistic regression model (AUROC 0.862, 95% CI 0.852-0.872; AUPRC 0.329, 95% CI 0.304-0.351). The performance of the ANN that used unnormalized data (AUROC 0.865, 95% CI 0.856-0.874) was slightly inferior to our highest performing ANN; the single-layer ANN architecture performed poorly and was not investigated further.ConclusionsA simple ANN model performed slightly better than the benchmark PIM-2 and PRISM-III scores and a traditional logistic regression model trained on the same data set. The small performance gains achieved by this two-layer ANN model may not offer clinically significant improvement; however, further research with other or more sophisticated model designs and better imputation of missing data may be warranted.

To compare the performance of the ACS NSQIP "universal" risk calculator (N-RC) to operation-specific RCs. Resources have been directed toward building operation-specific RCs because of an implicit belief that they would provide more accurate risk estimates than the N-RC. However, operation-specific calculators may not provide sufficient improvements in accuracy to justify the costs in development, maintenance, and access. For the N-RC, a cohort of 5,020,713 NSQIP patient records were randomly divided into 80% for machine learning algorithm training and 20% for validation. Operation-specific risk calculators (OS-RC) and OS-RCs with operation-specific predictors (OSP-RC) were independently developed for each of 6 operative groups (colectomy, whipple pancreatectomy, thyroidectomy, abdominal aortic aneurysm (open), hysterectomy/myomectomy, and total knee arthroplasty) and 14 outcomes using the same 80%/20% rule applied to the appropriate subsets of the 5M records. Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), and Hosmer-Lemeshow (H-L) P values, for 13 binary outcomes, and mean squared error for the length of stay outcome. The N-RC was found to have greater AUROC (P = 0.002) and greater AUPRC (P < 0.001) compared to the OS-RC. No other statistically significant differences in accuracy, across the 3 risk calculator types, were found. There was an inverse relationship between the operation group sample size and magnitude of the difference in AUROC (r = -0.278; P = 0.014) and in AUPRC (r = -0.425; P < 0.001) between N-RC and OS-RC. The smaller the sample size, the greater the superiority of the N-RC. While operation-specific RCs might be assumed to have advantages over a universal RC, their reliance on smaller datasets may reduce their ability to accurately estimate predictor effects. In the present study, this tradeoff between operation specificity and accuracy, in estimating the effects of predictor variables, favors the N-R, though the clinical impact is likely to be negligible.

Older adults with diabetes are at high risk of severe hypoglycemia (SH). Many machine-learning (ML) models predict short-term hypoglycemia are not specific for older adults and show poor precision-recall. We aimed to develop a multidimensional, electronic health record (EHR)-based ML model to predict one-year risk of SH requiring hospitalization in older adults with diabetes. We adopted a case-control design for a retrospective territory-wide cohort of 1,456,618 records from 364,863 unique older adults (age ≥65 years) with diabetes and at least 1 Hong Kong Hospital Authority attendance from 2013 to 2018. We used 258 predictors including demographics, admissions, diagnoses, medications, and routine laboratory tests in a one-year period to predict SH events requiring hospitalization in the following 12 months. The cohort was randomly split into training, testing, and internal validation sets in a 7:2:1 ratio. Six ML algorithms were evaluated including logistic-regression, random forest, gradient boost machine, deep neural network (DNN), XGBoost, and Rulefit. We tested our model in a temporal validation cohort in the Hong Kong Diabetes Register with predictors defined in 2018 and outcome events defined in 2019. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC) statistics, and positive predictive value (PPV). We identified 11,128 SH events requiring hospitalization during the observation periods. The XGBoost model yielded the best performance (AUROC = 0.978 [95% CI 0.972 to 0.984]; AUPRC = 0.670 [95% CI 0.652 to 0.688]; PPV = 0.721 [95% CI 0.703 to 0.739]). This was superior to an 11-variable conventional logistic-regression model comprised of age, sex, history of SH, hypertension, blood glucose, kidney function measurements, and use of oral glucose-lowering drugs (GLDs) (AUROC = 0.906; AUPRC = 0.085; PPV = 0.468). Top impactful predictors included non-use of lipid-regulating drugs, in-patient admission, urgent emergency triage, insulin use, and history of SH. External validation in the HKDR cohort yielded AUROC of 0.856 [95% CI 0.838 to 0.873]. Main limitations of this study included limited transportability of the model and lack of geographically independent validation. Our novel-ML model demonstrated good discrimination and high precision in predicting one-year risk of SH requiring hospitalization. This may be integrated into EHR decision support systems for preemptive intervention in older adults at highest risk.

Electronic health records (EHRs) with clinical decision support tools are now ubiquitous in healthcare organizations. Clinical foundation models (CFMs) pretrained on large-scale, heterogeneous structured EHR data have emerged as a powerful approach to improve predictive performance and generalizability. Meanwhile, large language models (LLMs) pretrained on broad data sources are being applied to an expanding range of healthcare tasks. However, it remains unclear whether generalist LLMs can match specialized CFMs for disease risk prediction using structured clinical data. We compared CFMs (Med-BERT, CLMBR) against fine-tuned generalist LLMs (Mistral, LLaMA-2/3/3.1), a clinical LLM (Me-LLaMA), and LLM-generated embeddings paired with simple classifiers (using DeepSeek, Qwen3, and GPT-OSS) on two disease risk prediction tasks: heart failure risk among diabetic patients (DHF) and pancreatic cancer diagnosis (PaCa). Evaluations spanned multi-site EHR data, claims data, and an open-source single-institution benchmark (EHRSHOT). Performance was assessed using the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). On larger EHR and claims cohorts (>30,000 patients), fine-tuned CFMs outperformed fine-tuned LLMs by a small but statistically significant margin (<1% AUROC). The clinical LLM performed comparably to generalist LLMs despite being smaller. On the open-source PaCa cohort (3,810 patients, 199 cases), LLMs achieved slightly higher AUROCs that were not statistically significant (LLaMA-3.1-70B 86.1% vs. Med-BERT 85.3%, p=0.27), but CFMs achieved significantly higher AUPRC (Med-BERT 55.9% vs. LLaMA-3.1-70B 41.1%, p=0.001). Notably, LLM-generated trajectory embeddings paired with logistic regression or a simple MLP, without any LLM fine-tuning, achieved the best overall performance, with AUROC exceeding 90% (Qwen3) and AUPRC reaching 66% (GPT-OSS 20B). LLM-generated embeddings with lightweight classifiers outperformed both fine-tuned CFMs and fine-tuned LLMs on AUROC and AUPRC. While these results demonstrate the potential of generalist models to match or surpass specialized CFMs, their substantially greater computational cost and variable AUPRC performance in the fine-tuning setting warrant caution. We provide a reproducible evaluation framework and codebase to support continued benchmarking.

Cardiac arrest (CA) is the leading cause of death in critically ill patients. Clinical research has shown that early identification of CA reduces mortality. Algorithms capable of predicting CA with high sensitivity have been developed using multivariate time series data. However, these algorithms suffer from a high rate of false alarms, and their results are not clinically interpretable. We propose an ensemble approach using multiresolution statistical features and cosine similarity-based features for the timely prediction of CA. Furthermore, this approach provides clinically interpretable results that can be adopted by clinicians. Patients were retrospectively analyzed using data from the Medical Information Mart for Intensive Care-IV database and the eICU Collaborative Research Database. Based on the multivariate vital signs of a 24-hour time window for adults diagnosed with heart failure, we extracted multiresolution statistical and cosine similarity-based features. These features were used to construct and develop gradient boosting decision trees. Therefore, we adopted cost-sensitive learning as a solution. Then, 10-fold cross-validation was performed to check the consistency of the model performance, and the Shapley additive explanation algorithm was used to capture the overall interpretability of the proposed model. Next, external validation using the eICU Collaborative Research Database was performed to check the generalization ability. The proposed method yielded an overall area under the receiver operating characteristic curve (AUROC) of 0.86 and area under the precision-recall curve (AUPRC) of 0.58. In terms of the timely prediction of CA, the proposed model achieved an AUROC above 0.80 for predicting CA events up to 6 hours in advance. The proposed method simultaneously improved precision and sensitivity to increase the AUPRC, which reduced the number of false alarms while maintaining high sensitivity. This result indicates that the predictive performance of the proposed model is superior to the performances of the models reported in previous studies. Next, we demonstrated the effect of feature importance on the clinical interpretability of the proposed method and inferred the effect between the non-CA and CA groups. Finally, external validation was performed using the eICU Collaborative Research Database, and an AUROC of 0.74 and AUPRC of 0.44 were obtained in a general intensive care unit population. The proposed framework can provide clinicians with more accurate CA prediction results and reduce false alarm rates through internal and external validation. In addition, clinically interpretable prediction results can facilitate clinician understanding. Furthermore, the similarity of vital sign changes can provide insights into temporal pattern changes in CA prediction in patients with heart failure-related diagnoses. Therefore, our system is sufficiently feasible for routine clinical use. In addition, regarding the proposed CA prediction system, a clinically mature application has been developed and verified in the future digital health field.

Coronary artery disease (CAD) results in substantial morbidity and mortality. The purpose of this study was to develop a deep learning model to detect CAD defined using diagnostic codes ("ECG2CAD") and identify people at risk for adverse events using electrocardiograms (ECGs) in a primary care setting. ECG2CAD was trained on 764,670 ECGs representing 137,199 individuals at Massachusetts General Hospital (MGH). Model performance for discrimination of prevalent CAD was measured using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC), and compared against model of age and sex, and Pooled Cohort Equations, in 3 test sets: MGH, Brigham and Women's Hospital (BWH), and UK Biobank. Subgroups were assessed for incident CAD-related events in a BWH primary care cohort. ECG2CAD was evaluated in MGH (N = 18,706 [6,051 cases], age 57 ± 16 years), BWH (N = 88,270 [27,898 cases], age 57 ± 16 years), and UK Biobank (N = 42,147 [1,509 cases], age 65 ± 8 years). ECG2CAD consistently discriminated prevalent CAD (MGH AUROC: 0.782; AUPRC: 0.639; BWH: AUROC: 0.747; AUPRC: 0.588; UK Biobank AUROC: 0.760; AUPRC: 0.155) and incrementally vs models based on age and sex or Pooled Cohort Equations (P < 0.01) in MGH and BWH. In the BWH primary care subset, model performance was consistent across subgroups. Being in the highest quintile of ECG2CAD risk was associated with higher risk for adverse events compared with low-risk group (myocardial infarction HR: 5.59; 95% CI: 4.76-6.56, heart failure 10.49; 95% CI: 7.96-13.84, all-cause mortality 2.68; 95% CI: 2.32-3.10). Artificial intelligence-enabled analysis of the ECG may facilitate identification of individuals with possible undiagnosed CAD and inform downstream testing and preventive measures.

Hospital-onset bacteremia and fungemia (HOB) are common and potentially preventable complications of hospital care. To assess whether nonindividual patient features, which summarize interactions with other patients and health care workers (HCWs), can contribute to predictive and causal machine learning models for HOB. This prognostic study included adult patients admitted to Barnes-Jewish Hospital, an academic hospital in St Louis, Missouri, in 2021. Analyses were developed between October 2023 and August 2024 and in April 2025. Individual patient features were extracted from electronic health records and used to engineer nonpatient features, including interactions with HCWs and direct or indirect (consecutive room occupancy) patient contact. HOB was defined as a positive blood culture after the third day of hospitalization. Patients who were hospitalized for more than 3 days were considered at risk for the outcome. We developed 3 gradient boosting models: 2 predictive (with patient features only and with both patient and nonpatient features to predict the occurrence of HOB) and 1 causal to test the association of nonpatient features and HOB. Predictive performance is reported using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC), and the results of the causal model are reported as difference in average effects. Sensitivity analyses separated intensive care unit-onset and ward-onset HOB and included a methicillin-resistant Staphylococcus aureus-specific model to adjust for colonization pressure. Among the 52 442 patients, 34 855 (66.5%) had admissions longer than 72 hours and were included for analysis; of these, 556 (1.6%) developed HOB. The median age for the included patients was 60 (IQR, 44-70) years, 50.5% were female, and obesity was the most frequent comorbidity (25.0%). Nonpatient features, such as a prior occupant of the same room receiving antipseudomonal beta-lactams and the mean number of HCWs per day for the 7 days preceding HOB, improved the model's performance (AUROC, 0.88 [95% CI, 0.88-0.89]; AUPRC, 0.20 [95% CI, 0.20-0.22]) compared with the patient-only model (AUROC, 0.85 [95% CI, 0.85-0.86]; AUPRC, 0.13 [95% CI, 0.12-0.14]) (P < .001). These 2 features were also associated with a higher likelihood of HOB in the causal gradient boosting model. These findings suggest that nonindividual patient features may contribute to a comprehensive analysis of HOB when integrated with individual patient features in a machine learning model.

Fog computing extends cloud services to the network edge, enabling low-latency processing for Internet of Things (IoT) applications. However, this distributed approach is vulnerable to a wide range of attacks, necessitating advanced intrusion detection systems (IDSs) that operate under resource constraints. This study proposes integrating self-awareness (online learning and concept drift adaptation) into a lightweight RL (reinforcement learning)-based IDS for fog networks and quantitatively comparing it with non-RL static thresholds and bandit-based approaches in real time. Novel self-aware reinforcement learning (RL) models, the Hierarchical Adaptive Thompson Sampling–Reinforcement Learning (HATS-RL) model, and the Federated Hierarchical Adaptive Thompson Sampling–Reinforcement Learning (F-HATS-RL), were proposed for real-time intrusion detection in a fog network. These self-aware RL policies integrated online uncertainty estimation and concept-drift detection to adapt to evolving attacks. The RL models were benchmarked against the static threshold (ST) model and a widely adopted linear bandit (Linear Upper Confidence Bound/LinUCB). A realistic fog network simulator with heterogeneous nodes and streaming traffic, including multi-type attack bursts and gradual concept drift, was established. The models’ detection performance was compared using metrics including latency, energy consumption, detection accuracy, and the area under the precision–recall curve (AUPR) and the area under the receiver operating characteristic curve (AUROC). Notably, the federated self-aware agent (F-HATS-RL) achieved the best AUROC (0.933) and AUPR (0.857), with a latency of 0.27 ms and the lowest energy consumption of 0.0137 mJ, indicating its ability to detect intrusions in fog networks with minimal energy. The findings suggest that self-aware RL agents can detect traffic–dynamic attack methods and adapt accordingly, resulting in more stable long-term performance. By contrast, a static model’s accuracy degrades under drift.

Background/Introduction Most artificial intelligence-enabled electrocardiography (AI-ECG) research on single-lead ECG has primarily utilized Lead I data from the standard 12-lead ECG (S-Lead I) for model training. However, it remains uncertain whether the results validated using only S-Lead I data in conventional studies can be directly applied to wearable devices such as smartwatches. S-Lead I and the Lead I that acquired via a smartwatch (W-Lead I) differ substantially in sensor characteristics, noise patterns, and measurement methods. These discrepancies in data properties suggest that a model trained solely on S-Lead I may experience a decline in performance when applied directly to W-Lead I. Despite these concerns, there is limited evidence quantifying this performance gap. Purpose The primary goal of this study was to evaluate the generalizability of an AI-enabled left ventricular systolic dysfunction (LVSD) prediction model, trained on S-Lead I, when applied to W-Lead I. We examined the correlation between S-Lead I and W-Lead I performance throughout model training to determine whether improvements on S-Lead I were consistently reflected in W-Lead I, ensuring the model's generalizability across different ECG acquisition methods. Method We retrospectively collected 151,065 S-Lead I ECGs from 151,137 patients who underwent echocardiography within 14 days at Hospital A between 2017 and 2024, forming an ECG cohort. Additionally, we collected 2,441 W-Lead I data recorded within 24 hours of S-Lead I. The paired S-Lead I and W-Lead I data were used for model evaluation, while the S-Lead I data alone were used for model training. Predictive performance was assessed using the mean of the area under the receiver operating characteristic curve (AUROC) and the area under the precision–recall curve (AUPRC). In addition, correlation values were calculated across every training iteration to quantify how well performance trends on S-Lead I translated to W-Lead I. Results As shown in Figure 1.B , both the training dataset and the S-Lead I test set demonstrated a steady improvement in AUROC and AUPRC throughout the iterative training process, maintaining a strong performance correlation of 0.89 or higher. In contrast, the Apple Watch and Galaxy W-Lead I test sets displayed more pronounced fluctuations in performance and did not follow the same upward trend, with notably lower correlation values (Apple Watch: 0.54; Galaxy Watch: 0.69; see Figure 1.C). These results indicate that a model trained exclusively on S- Lead I may not sufficiently capture the sensor-specific and physiological nuances of W-Lead I. Conclusion The results indicate that an LVSD prediction model trained exclusively on S-Lead I has limited generalizability when applied to real-world W-Lead I data. Future efforts should focus on developing algorithms that incorporate the watch signal characteristics of smartwatch ECG, thereby enhancing clinical utility.

Multi-modal fusion model for Time-Varying medical Data: Addressing Long-Term dependencies and memory challenges in sequence fusion.

Patients with non-small cell lung cancer (NSCLC) and patients with NSCLC combined with chronic obstructive pulmonary disease (COPD) have similar physiological conditions in early stages, and the latter have shorter survival times and higher mortality rates. The purpose of this study was to develop and compare machine learning models to identify future diagnoses of COPD combined with NSCLC patients based on the patient's disease and routine clinical data. Data were obtained from 237 patients with COPD combined with NSCLC as well as NSCLC admitted to Ningxia Hui Autonomous Region People's Hospital from October 2013 to July 2022. Six machine learning algorithms (K-nearest neighbor, logistic regression, eXtreme gradient boosting, support vector machine, naïve Bayes, and artificial neural network) were used to develop prediction models for NSCLC combined with COPD. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F1 score, Mathews correlation coefficient (MCC), Kappa, area under the receiver operating characteristic curve (AUROC)and area under the precision-recall curve (AUPRC) were used as performance indicators to evaluate the performance of the models. 135 patients with NSCLC combined with COPD, 102 patients with NSCLC were included in the study. The results showed that pulmonary function and emphysema were important risk factors and that the support vector machine-based identification model showed optimal performance with accuracy:0.946, recall:0.940, specificity:0.955, precision:0.972, npv:0.920, F1 score:0.954, MCC:0.893, Kappa:0.888, AUROC:0.975, AUPRC:0.987. The use of machine learning tools combining clinical symptoms and routine examination data features is suitable for identifying the risk of concurrent NSCLC in COPD patients.

Purpose: Lung cancer screening (LCS) lowers cancer mortality if individuals adhere to annual scans. Minoritized communities have significantly lower adherence to LCS than non-Hispanic whites. The influence of social determinants of health (SDOH) on these disparate adherence rates are rarely evaluated. The aim of this study is to develop a machine learning (ML) model that integrates individual and neighborhood level SDOH to predict which minoritized individuals are at risk of LCS non-adherence. Methods: A total of 168 participants with high-risk smoking histories who underwent their first low dose computed tomography (LDCT) between 2017 and 2021 were enrolled. Surveys on SDOH and perceived discrimination were completed. Participants’ addresses were joined to neighborhood level SDOH data from various publicly available sources. These indices captured neighborhood socioeconomic status and segregation. Adherence rates were calculated by assessing electronic medical records to determine if participants had a second LDCT within 15 months. Participants were temporally split into training (N=125) and testing (N=43) sets with a cut-off date of June 30, 2021. A gradient boosting classifier, XGBoost, was trained to predict LCS non-adherence, incorporating variables such as sociodemographic status, perceived discrimination, previous screenings, smoking status, and geospatial indices. The SHapley Additive exPlanations (SHAP) method was used to determine the relative importance of each feature in the model’s predictions. Results: The participants represented a diverse group: Asian (26%), Black/African American (32%), and Hispanic/Latino (32%). The LCS non-adherence rates were 66% in the training set and 63% in the testing set. The XGBoost classifier achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.79 and an Area Under the Precision-Recall Curve (AUPRC) of 0.90, outperforming a simple logistic regression model (AUROC=0.63 and AUPRC=0.79). The XGBoost classifier’s performance metrics were Accuracy=0.77, Recall=0.85, Specificity=0.62, Positive Predictive Value=0.79, and Negative Predictive Value=0.71. The SHAP analysis indicated that participants with no prior history of colorectal cancer screening, who lived in areas with lower quality school systems, and with a higher percentage of individuals below the poverty line, were at a higher risk of non-adherence to LCS. Conclusions: LCS reduces lung cancer survival, but LCS adherence is significantly lower in minoritized groups. Our ML model strongly predicted LCS non-adherence based on SDOH and geospatial factors. Specific neighborhood level SDOHs predicted LCS non-adherence more strongly than individual level factors. These findings support interventions that address both individual and neighborhood-level barriers to increase LCS adherence. Citation Format: Kun-Han Lu, Yi Xiao, Aamna Akhtar, Jazma Tapia, Calvin Tribby, Jay Yang, Marta Jankowska, Chi Wah Wong, Loretta Erhunmwunsee. Predicting lung cancer screening adherence among underserved and minoritized communities using social determinants and neighborhood factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4971.

TDAGENE: Inference of Gene Regulatory Network Based on Topological Data Analysis and Graph Attention Network for Single-Cell RNA Sequencing Data.

BACKGROUND Timely and accurate prediction of short-term mortality is critical in intensive care units (ICUs), where patients’ conditions change rapidly. Traditional scoring systems, such as the Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation, rely on static variables collected within the first 24 hours of admission and do not account for continuously evolving clinical states. These systems lack real-time adaptability, interpretability, and generalizability. With the increasing availability of high-frequency electronic medical record (EMR) data, machine learning (ML) approaches have emerged as powerful tools to model complex temporal patterns and support dynamic clinical decision-making. However, existing models are often limited by their inability to handle irregular sampling and missing values, and many lack rigorous external validation across institutions. OBJECTIVE We aimed to develop a real-time, interpretable risk prediction model that continuously assesses ICU patient mortality using irregular, longitudinal EMR data, with improved performance and generalizability over traditional static scoring systems. METHODS A time-aware bidirectional attention-based long short-term memory (TBAL) model was developed using EMR data from the MIMIC-IV (Medical Information Mart for Intensive Care) and eICU Collaborative Research Database (eICU-CRD) databases, comprising 176,344 ICU stays. The model incorporated dynamic variables, including vital signs, laboratory results, and medication data, updated hourly, to perform static and continuous mortality risk assessments. External cross-validation and subgroup sensitivity analyses were conducted to evaluate robustness and fairness. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), accuracy, and &lt;i&gt;F&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;-score. Interpretability was enhanced using integrated gradients to identify key predictors. RESULTS For the static 12-hour to 1-day mortality prediction task, the TBAL model achieved AUROCs of 95.9 (95% CI 94.2-97.5) and 93.3 (95% CI 91.5-95.3) and AUPRCs of 48.5 and 21.6 in MIMIC-IV and eICU-CRD, respectively. Accuracy and &lt;i&gt;F&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;-scores reached 94.1 and 46.7 in MIMIC-IV and 92.2 and 28.1 in eICU-CRD. In dynamic prediction tasks, AUROCs reached 93.6 (95% CI 93.2-93.9) and 91.9 (95% CI 91.6-92.1), with AUPRCs of 41.3 and 50, respectively. The model maintained high recall for positive cases (82.6% and 79.1% in MIMIC-IV and eICU-CRD). Cross-database validation yielded AUROCs of 81.3 and 76.1, confirming generalizability. Subgroup analysis showed stable performance across age, sex, and severity strata, with top predictors including lactate, vasopressor use, and Glasgow Coma Scale score. CONCLUSIONS The TBAL model offers a robust, interpretable, and generalizable solution for dynamic real-time mortality risk prediction in ICU patients. Its ability to adapt to irregular temporal patterns and to provide hourly updated predictions positions it as a promising decision-support tool. Future work should validate its utility in prospective clinical trials and investigate its integration into real-world ICU workflows to enhance patient outcomes. CLINICALTRIAL

Accurate hospital length of stay (LoS) prediction enables efficient resource management. Conventional LoS prediction models with limited covariates and nonstandardized data have limited reproducibility when applied to the general population. In this study, we developed and validated a machine learning (ML)-based LoS prediction model for planned admissions using the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM). Retrospective patient-level prediction models used electronic health record (EHR) data converted to the OMOP CDM (version 5.3) from Seoul National University Bundang Hospital (SNUBH) in South Korea. The study included 137,437 hospital admission episodes between January 2016 and December 2020. Covariates from the patient, condition occurrence, medication, observation, measurement, procedure, and visit occurrence tables were included in the analysis. To perform feature selection, we applied Lasso regularization in the logistic regression. The primary outcome was an LoS of 7 days or longer, while the secondary outcome was an LoS of 3 days or longer. The prediction models were developed using 6 ML algorithms, with the training and test set split in a 7:3 ratio. The performance of each model was evaluated based on the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Shapley Additive Explanations (SHAP) analysis measured feature importance, while calibration plots assessed the reliability of the prediction models. External validation of the developed models occurred at an independent institution, the Seoul National University Hospital. The final sample included 129,938 patient entry events in the planned admissions. The Extreme Gradient Boosting (XGB) model achieved the best performance in binary classification for predicting an LoS of 7 days or longer, with an AUROC of 0.891 (95% CI 0.887-0.894) and an AUPRC of 0.819 (95% CI 0.813-0.826) on the internal test set. The Light Gradient Boosting (LGB) model performed the best in the multiclassification for predicting an LoS of 3 days or more, with an AUROC of 0.901 (95% CI 0.898-0.904) and an AUPRC of 0.770 (95% CI 0.762-0.779). The most important features contributing to the models were the operation performed, frequency of previous outpatient visits, patient admission department, age, and day of admission. The RF model showed robust performance in the external validation set, achieving an AUROC of 0.804 (95% CI 0.802-0.807). The use of the OMOP CDM in predicting hospital LoS for planned admissions demonstrates promising predictive capabilities for stays of varying durations. It underscores the advantage of standardized data in achieving reproducible results. This approach should serve as a model for enhancing operational efficiency and patient care coordination across health care settings.