arXiv:2601.06645eess.SPcs.LG2026-01被引 3

融合心电图与临床数据的AI模型,可精准预测重症患者多种风险。

A Multimodal Deep Learning Framework for Predicting ICU Deterioration: Integrating ECG Waveforms with Clinical Data and Clinician Benchmarking

  • 用深度学习融合心电图和多源临床数据进行联合建模
  • 24小时死亡率预测AUROC达0.90,通气需求预测达0.97
  • 优于医生和大模型,适合用于临床决策支持

人工智能在重症监护中具有巨大潜力,但现有模型多仅关注单一结局或有限数据类型,而临床决策需综合长期病史、实时生理与异构临床信息。为此,我们构建了MDS ICU——一个统一的多模态机器学习框架,融合人口学、生命体征、实验室指标、心电图波形、手术记录及医疗设备使用等常规数据,在整个ICU住院期间提供持续风险预测。基于MIMIC IV中27,062名患者的63,001条样本训练模型,采用结构化状态空间S4编码器处理心电图波形,结合多层感知机RealMLP编码器处理表格数据,联合预测33种临床相关结局,涵盖死亡率、器官功能障碍、用药需求及急性恶化。模型表现优异:24小时死亡率预测AUROC为0.90,镇静药物使用为0.92,有创机械通气为0.97,凝血功能障碍为0.93。校准分析显示预测风险与实际发生率高度一致,且心电图整合带来显著性能提升。与临床医生及大语言模型对比发现,仅依赖模型预测已优于两者,若将模型输出作为辅助,更进一步提升医生表现。结果表明,多模态AI可在多种重症结局上实现临床有效的风险分层,增强而非替代临床判断,为精准危重症决策支持建立可扩展基础。

原文摘要 · Abstract (English)

Artificial intelligence holds strong potential to support clinical decision making in intensive care units where timely and accurate risk assessment is critical. However, many existing models focus on isolated outcomes or limited data types, while clinicians integrate longitudinal history, real time physiology, and heterogeneous clinical information. To address this gap, we developed MDS ICU, a unified multimodal machine learning framework that fuses routinely collected data including demographics, biometrics, vital signs, laboratory values, ECG waveforms, surgical procedures, and medical device usage to provide continuous predictive support during ICU stays. Using 63001 samples from 27062 patients in MIMIC IV, we trained a deep learning architecture that combines structured state space S4 encoders for ECG waveforms with multilayer perceptron RealMLP encoders for tabular data to jointly predict 33 clinically relevant outcomes spanning mortality, organ dysfunction, medication needs, and acute deterioration. The model achieved strong discrimination with AUROCs of 0.90 for 24 hour mortality, 0.92 for sedative administration, 0.97 for invasive mechanical ventilation, and 0.93 for coagulation dysfunction. Calibration analysis showed close agreement between predicted and observed risks, with consistent gains from ECG waveform integration. Comparisons with clinicians and large language models showed that model predictions alone outperformed both, and that providing model outputs as decision support further improved their performance. These results demonstrate that multimodal AI can deliver clinically meaningful risk stratification across diverse ICU outcomes while augmenting rather than replacing clinical expertise, establishing a scalable foundation for precision critical care decision support.

重症监护多模态学习心电图分析临床决策

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