SepsisSuite: Beyond Risk Stratification -- A Comparative Analysis of Deep Fusion vs. Expert Stacking for Prescriptive Sepsis AI

Abstract

Sepsis accounts for nearly 20% of global ICU admissions, yet conventional prediction models often fail to effectively integrate heterogeneous data streams, remaining either siloed by modality or reliant on brittle early fusion. In this work, we present a rigorous architectural comparison between End-to-End Deep Fusion and Context-Aware Stacking for sepsis tasks. We initially hypothesized that a novel Quad-Modal Hierarchical Gated Attention Network -- termed SepsisFusionFormer -- would resolve complex cross-modal interactions between vitals, text, and imaging. However, experiments on MIMIC-IV revealed that SepsisFusionFormer suffered from "attention starvation" in the small antibiotic cohort ($N \approx 2,100$), resulting in overfitting (AUC 0.66). This counterintuitive result informed the design of SepsisLateFusion, a "leaner" Context-Aware Mixture-of-Experts (MoE) architecture. By treating modalities as orthogonal experts -- the "Historian" (Static), the "Monitor" (Temporal), and the "Reader" (NLP) -- and dynamically gating them via a CatBoost meta-learner, we achieved State-of-the-Art (SOTA) performance: 0.915 AUC for prediction 4 hours prior to clinical onset. By calibrating the decision threshold for clinical safety, we reduced missed cases by 48% relative to the default operating point, thus opening a true preventative window for timely intervention over reactive alerts. Furthermore, for the novel prescriptive task of multi-class antibiotic selection, we demonstrate that a Quad-Modal Ensemble achieved the highest performance (0.72 AUC). These models are integrated into SepsisSuite, a deployment-ready Python framework for clinical decision support. SepsisSuite is available for free at: https://github.com/RyanCartularo/SepsisSuite-Info