{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T01:13:09Z","timestamp":1779153189732,"version":"3.51.4"},"reference-count":18,"publisher":"The Korean Society of Medical Informatics","issue":"2","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Agency for Research and Development of Moldova","award":["25.00208.5007.07\/PD"],"award-info":[{"award-number":["25.00208.5007.07\/PD"]}]},{"name":"Technical University of Moldova","award":["PN-IV-PCB-RO-MD-2024-0364"],"award-info":[{"award-number":["PN-IV-PCB-RO-MD-2024-0364"]}]}],"content-domain":{"domain":["e-hir.org"],"crossmark-restriction":true},"short-container-title":["Healthc Inform Res"],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:p>Objectives: This study evaluated the feasibility and performance of a multi-agent (MA) system designed to support early sepsis management in intensive care units. The system integrates three specialized agents\u2014sepsis management, antibiotic recommendation, and guideline compliance\u2014to provide evidence-based recommendations at T = 0 hours (before culture results), extending prior single-case findings across 10 diverse cases.Methods: The MA system was powered by Palmyra- Med 70B (selected for superior MedQA performance [average score, 85.9]) and compared with GPT-3.5 Turbo and GPT-4o mini (all at a temperature of 0.25). It used retrieval-augmented generation (RAG) with ChromaDB (2021 Surviving Sepsis Campaign, over 20 high-impact manuscripts [reviews published 2018\u20132025] on sepsis etiologies, and other relevant sources). Eight cases from the MIMIC-IV demo and two cases from the literature were formatted as vignettes. RAG used the BAAI\/bge-base-en-v1.5 embedding model with cosine similarity (threshold, 0.75) and top-5 chunks. Performance was assessed via TruLens (groundedness, approximately 0.62) and by two intensivists using a standardized questionnaire.Results: The system generated guideline-compliant recommendations (e.g., prompt surgical debridement plus meropenem and vancomycin for necrotizing fasciitis). Hallucinations occurred in three of 10 cases (e.g., \u201caltered mental status\u201d). Expert agreement was quantified by a Cohen kappa of 0.26. Programmatic and expert assessments showed negligible correlation.Conclusions: In this exploratory study, the MA system shows preliminary promise for early sepsis support but requires human oversight to mitigate hallucinations. Code is available in GitHub; further validation is needed.<\/jats:p>","DOI":"10.4258\/hir.2026.32.2.190","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:57:31Z","timestamp":1778223451000},"page":"190-195","update-policy":"https:\/\/doi.org\/10.4258\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-Agent System for Early Sepsis Management Support: A Follow-up Evaluation Study"],"prefix":"10.4258","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4540-7045","authenticated-orcid":true,"given":"Victor","family":"Iapascurta","sequence":"first","affiliation":[{"name":"Department of Software Engineering and Automatics, Technical University of Moldova, Chisinau, Republic of Moldova"},{"name":"Department of Anesthesia and Intensive Care, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5540-4246","authenticated-orcid":true,"given":"Dinu","family":"Turcanu","sequence":"additional","affiliation":[{"name":"Department of Software Engineering and Automatics, Technical University of Moldova, Chisinau, Republic of Moldova"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4128-1318","authenticated-orcid":true,"given":"Adrian","family":"Belii","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-3538","authenticated-orcid":true,"given":"Viorel","family":"Bostan","sequence":"additional","affiliation":[{"name":"Department of Software Engineering and Automatics, Technical University of Moldova, Chisinau, Republic of Moldova"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2780","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201609-1848OC"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.4258\/hir.2025.31.2.209"},{"key":"ref4","volume-title":"","author":"Johnson","year":"2023"},{"key":"ref5","volume-title":"","author":"Guo","year":"2024"},{"key":"ref6","volume-title":"","author":"Gao","year":"2024"},{"key":"ref7","volume-title":"","year":"2024"},{"key":"ref8","volume-title":"","year":"2024"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06506-y"},{"key":"ref10","volume-title":"","year":"2024"},{"key":"ref11","volume-title":"","year":"2024"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.52326\/jes.utm.2024.31(2).05"},{"key":"ref13","volume-title":"","year":"2024"},{"key":"ref14","volume-title":"","year":"2024"},{"key":"ref15","volume-title":"","year":"2024"},{"key":"ref16","volume-title":"","author":"Xu","year":"2025"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-024-07421-0"},{"key":"ref18","volume-title":"","author":"Edemekong","year":"2025"}],"container-title":["Healthcare Informatics Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-hir.org\/upload\/pdf\/hir-2026-32-2-190.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-hir.org\/journal\/view.php?doi=10.4258\/hir.2026.32.2.190","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-hir.org\/upload\/pdf\/hir-2026-32-2-190.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T01:05:33Z","timestamp":1779152733000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-hir.org\/journal\/view.php?doi=10.4258\/hir.2026.32.2.190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.4258\/hir.2026.32.2.190","relation":{},"ISSN":["2093-369X"],"issn-type":[{"value":"2093-369X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"assertion":[{"value":"2025-04-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-30","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}