基于多模态病历的智能体式LLM推理用于儿童糖尿病结局预测
Agentic LLM reasoning in pediatric diabetes outcome prediction from multimodal medical records
Daniel Palacios, Guantong Qi, Anna Kadi, Natali Borrego, Sukru Aras, Michael L. Ferm, Elizabeth Kubota-Mishra, Maria J. Redondo 等 11 位作者
AI 速览：作者提出证据引用、自我审计的LLM智能体流水线CEDAR，在儿童T2D与T1D队列中预测24个月结局，报告其判别性能优于所比较的机器学习模型。
Large language model (LLM) agents are proposed for clinical prediction but are untested in pediatrics, where cohorts are small and outcomes are uncommon. Using records from 2,489 youth with type 2 diabetes (T2D) and 4,018 with type 1 diabetes (T1D), spanning structured data, note-derived social determinants and, in T1D, continuous glucose monitoring data, we predicted seven T2D outcomes, four also in T1D, at 24 months from 18 months of follow-up. CEDAR (Clinical Evidence-Driven Agent for Risk-prediction), an evidence-citing, self-auditing LLM pipeline, outperformed trained machine learning in both cohorts (pooled area under the receiver operating characteristic curve 0.815 versus 0.656 to 0.700 in T2D and 0.756 versus 0.603 to 0.631 in T1D), most on the sparsely screened outcomes. Only 4 of 70,246 values it cited did not match the chart. Reading only the evidence and reasoning cited by CEDAR, two pediatric endocrinologists reached the same prediction as CEDAR in about nine of ten cases, agreeing with each other on 90.5%.