CNA: An AI-Oriented Comprehensive Normalized Assessment for Healthy Status and Application to Optimize RRT Strategies by Reinforcement Learning

Abstract

Millions worldwide require Renal Replacement Therapy (RRT) as a treatment essential for survival. However, optimizing RRT strategies via AI is challenging due to heterogeneous patient dynamics, missing data, and the absence of an AI-oriented health assessment criterion. We propose an AI-Oriented Comprehensive Normalized Assessment (CNA) for healthy status and apply it to optimize RRT strategies by using offline reinforcement learning (RL). The key idea of CNA is transforming vital-sign distributions into a standard normal space, enabling a unified, data-driven health-status score defined by deviations from referent intervals, which also provides an AI-oriented criterion to assess strategy quality and supports RL termination. We further design a structured 23-dimensional state representation that integrates 19 indicators with 4 RRT descriptors, and employ matrix decomposition to reconstruct missing vital signs, improving data completeness for learning. These components are incorporated into multiple offline RL algorithms and validated via systematic ablation studies on RRT feature subsets. Compared with physicians' observed treatments, the best learned strategy reduces mortality from 13.2% to 5.0% (reducing 62.24%) and shortens average in-hospital stay from 308.5 to 250.1 hours (reducing 18.93%), demonstrating both methodological innovation and the potential of CNA-guided RL to improve RRT outcomes in nephrology.