Abstract
Predicting future organ dysfunction in Intensive Care Unit (ICU) patients is critical for early clinical intervention, yet existing machine learning approaches have largely treated the Sequential Organ Failure Assessment (SOFA) score as an input to binary mortality prediction rather than as a continuous clinical outcome in its own right. We investigate the extent to which a Temporal Convolutional Net work (TCN) can predict next-day SOFA scores from multivariate ICU time-series data extracted from MIMIC-IV, characterise the relative contribution of each organ system to total SOFA variance and deterioration, and identify distinct trajectory patterns across ICU stays. A residual TCN trained on three-day sliding windows achieved a five-fold cross-validation R2 of 0.740 +- 0.013 and MAE of 1.431 +- 0.022, outperforming a naive persistence baseline on RMSE and R2. SHAP interpretability analysis revealed that the model functions primarily as a severity-anchoring mechanism rather than a true sequence model, with predictions dominated almost entirely by the most recent observation day. Cardiovascular dysfunction emerged as the strongest discriminator of both cross-sectional severity and acute deterioration, and unsupervised trajectory clustering identified two clinically meaningful phenotypes, an improving group (58.9%) and a persistently severe group (41.1%), differentiated by cardiovascular, hepatic, coagulation, and renal involvement. We conclude that TCNs can extract meaningful predictive signal from ICU physiological data, but that short input windows and complete-case selection bias currently limit their clinical utility, motivating future work on longer input horizons, alternative missing-data strategies, and external validation.
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URL
https://arxiv.org/abs/2608.29301
