Multi-Large Language Model Orchestrated Severity Assessment of Clinical Records (MOSAIC)
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Computer Science > Computation and Language
arXiv:2607.05032 (cs)
[Submitted on 6 Jul 2026]
Title:Multi-Large Language Model Orchestrated Severity Assessment of Clinical Records (MOSAIC)
Authors:Manuela Del Castillo Suero, Arnault-Quentin Vermillet, Nicole Sonne Heckmann, Darmendra Ramcharran, Maurizio Sessa
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Abstract:Background: Disease severity is a multidimensional construct difficult to capture with rule-based approaches in Electronic Healthcare Records (EHR). Agentic large language model (LLM) systems could synthesise clinical evidence and reason over EHRs, but remain unevaluated for this task. Methods: MOSAIC is a two-phase agentic LLM framework for severity phenotyping, using type 2 diabetes (T2D) as a proof-of-concept. MOSAIC was evaluated on a synthetic cohort (SyntheticMass; open-weight N = 4,886; closed-weight N = 200) against three algorithmic ground truths (DCSI, DiSSCo, Cooper) and against all-cause mortality and incident complications. Open-weight (locally deployable) and proprietary pipelines were also compared. Results: The generated framework spanned domains absent from the comparators, including biomarker-based glycaemic staging, beta-cell function, and social determinants of health. Open-weight MOSAIC matched the proprietary pipeline (closed- vs open-weight weighted kappa = 0.773) and reached moderate agreement with Cooper (kappa = 0.597) and DCSI (kappa = 0.534) and fair agreement with DiSSCo (kappa = 0.320). Agent-based (Type 1) tiers showed significant separation of all-cause mortality (log-rank p < 0.001; crude hazard ratios 1.6-2.4 for non-Baseline tiers), with non-monotonic separation at the upper tiers, and an inverse gradient for incident complications (log-rank p < 0.001) consistent with depletion of susceptibles. Agentic classification also diverged from deterministic execution of the same rubric (MOSAIC Frozen; kappa = 0.428), indicating reasoning beyond fixed rules. Conclusion: MOSAIC shows agentic LLM systems can generate and apply clinically meaningful severity phenotypes from structured EHR data in T2D. Extending it to other diseases with similarly multidimensional severity warrants further research.
| Subjects: | Computation and Language (cs.CL) |
| Cite as: | arXiv:2607.05032 [cs.CL] |
| (or arXiv:2607.05032v1 [cs.CL] for this version) | |
| https://doi.org/10.48550/arXiv.2607.05032
arXiv-issued DOI via DataCite (pending registration)
|
Submission history
From: Maurizio Sessa Dr. [view email][v1] Mon, 6 Jul 2026 13:15:21 UTC (2,734 KB)
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