Explainable Graph Neural Networks in Intensive Care Unit Mortality Prediction: Edge-Level and Motif-Level Analysis

Year 2025, Volume: 9 Issue: 2, 770 - 789, 31.12.2025

Şebnem Akal

https://doi.org/10.26650/acin.1835775

https://izlik.org/JA38PB99AH

Abstract

Accurate forecasting of ICU patient outcomes is essential for clinical decision support. However, most high-performing machine learning models function as black boxes, limiting their interpretability and clinical adoption. This study introduces a graph-based explainable risk-prediction framework, in which patient–patient relations are modeled through a diagnosis-based similarity network. An undirected graph was derived from the eICU-CRD demo subset (PhysioNet v2.0) by linking individuals sharing three-digit ICD-9 categories, and a GCN was trained for in-hospital mortality prediction. Despite the dataset’s modest size and imbalance, meaningful discrimination was achieved (AUROC = 0.708; AUPRC = 0.308). A two-layer explainability analysis was applied to clarify the model’s decision process. Each prediction was driven by a combination of patient-specific clinical attributes and signals from a small number of influential neighbors, according to GNNExplainer. SubgraphX, a Shapley-value-based motif discovery method, identified compact and clinically coherent subgraphs with strong causal influence on the prediction. Consistency between edge- and motif-level explanations indicated that the model relies on stable relational patterns with clinical relevance. These findings suggest that integrating GNNs with structured explainability methods can transform a single risk score into a transparent, data-driven decision-support mechanism that provides interpretable and hypothesis-generating insights to clinicians.

Keywords

Explainable Graph Neural Networks , GNNExplainer , SubgraphX

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