Leger, Rachel

Abstract Background Interpretation of multi-analyte laboratory profiles, such as lupus anticoagulant (LAC) testing, requires integration of numerous test results and clinical information. However, this process is time-consuming, requires domain knowledge, and has limited scalability. Given that rule-based systems are rigid and difficult to maintain and large language models pose risks of “hallucinations,” we developed and evaluated a novel retrieval-based approach to automate LAC profile interpretation to improve efficiency while maintaining fidelity and reliability for clinical use. Methods Our method processes laboratory values through ensemble random forest (RF) models to retrieve the most similar expert interpretation from a curated database of 347 previously interpreted LAC profiles. The system's performance was assessed through technical accuracy metrics, a work flow efficiency timing study, and expert review of interpretation accuracy for held-out cases. Results Technical validation demonstrated high accuracy in retrieving correct interpretative elements (median: 93% accuracy, interquartile range [IQR]: 67% to 100%). Retrieval accuracy was highly correlated with the prevalence of a given element (ρ = 0.8307). In a timing study of 93 consecutive LAC profiles, ensemble-assisted interpretation achieved a median time of 22 s per report (IQR: 16 s to 31 s), representing a 78.6% total reduction compared to manual interpretation (median: 118 s, IQR: 96 s to 172 s; t = 18.61, P < 0.001). Furthermore, 92.5% of AI-assisted interpretations were completed within 60 s, exceeding the target of 85%. Expert review confirmed 100% concordance for LAC presence/absence. Conclusions The proposed approach significantly improves efficiency of complex laboratory interpretation for LAC profiles, while maintaining consistency and high fidelity. Future studies will explore the method’s inherent extensibility to the interpretation of other multi-analyte laboratory profiles.