ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606254
Potential source of bias in AI models: Lactate measurement in the ICU in sepsis patients as a template
Provisionally accepted
Pratiksha Pradhan1Fredrik Willumsen1Nebal S Abu Hussein2
Dana M1
Lama Moukheiber1
Mira Moukheiber1Sulaiman Moukheiber3Luca Leon Weishaupt1Jacob G Ellen4Helen D ' Couto5Ishan C Williams6Leo Celi1
João Matos1
Tristan Struja1,7*- 1Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
- 2Yale University, New Haven, Connecticut, United States
- 3Worcester Polytechnic Institute, Worcester, Massachusetts, United States
- 4Harvard Medical School, Boston, Massachusetts, United States
- 5Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
- 6University of Virginia, Charlottesville, Virginia, United States
- 7Aarau Cantonal Hospital, Aarau, Switzerland
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Objective: Health inequities may be driven by demographics such as sex, language proficiency, and race-ethnicity. These disparities may manifest through likelihood of testing, which in turn can bias artificial intelligence models. We aimed to evaluate variation in serum lactate measurements in the Intensive Care Unit (ICU) in sepsis. Methods: Utilizing MIMIC-IV (2008-2019), we identified adults fulfilling sepsis-3 criteria. Exclusion criteria were ICU stay <1-day, unknown race-ethnicity, <18 years of age, and recurrent ICU-stays. Employing targeted maximum likelihood estimation analysis, we assessed the likelihood of a lactate measurement on day 1. For patients with a measurement on day 1, we evaluated the predictors of subsequent readings. Results: We studied 15,601 patients (19.5% racial-ethnic minority, 42.4% female, and 10.0% limited English proficiency). After adjusting for confounders, Black patients had a slightly higher likelihood of receiving a lactate measurement on day 1 (odds ratio 1.19, 95% confidence interval (CI) 1.06-1.34), but not the other minority groups. Subsequent frequency was similar across race-ethnicities, but women had a lower incidence rate ratio (IRR) 0.94 (95% CI 0.90-0.98). Patients with elective admission and private insurance also had a higher frequency of repeated serum lactate measurements (IRR 1.70, 95% CI 1.61-1.81, and 1.07, 95% CI, 1.02-1.12, respectively). Conclusion: We found no disparities in the likelihood of a lactate measurement among patients with sepsis across demographics, except for a small increase for Black patients, and a reduced frequency for women. Subsequent analyses should account for the variation in biomarker monitoring being present in MIMIC-IV.
Keywords: Sepsis, Lactate, MIMIC-IV, Critical Care, Health Equity Pradhan and Haug. Administrative, Technical, or material support: Celi. Supervision: Struja, CELI
Received: 04 Apr 2025; Accepted: 20 Jun 2025.
Copyright: © 2025 Pradhan, Willumsen, Abu Hussein, M, Moukheiber, Moukheiber, Moukheiber, Weishaupt, Ellen, Couto, Williams, Celi, Matos and Struja. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tristan Struja, Aarau Cantonal Hospital, Aarau, Switzerland
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