Stable CDE Autoencoders with Acuity Regularization for Offline Reinforcement Learning in Sepsis Treatment

Abstract: Effective reinforcement learning (RL) for sepsis treatment depends on learning stable, clinically meaningful state representations from irregular ICU time series. While previous works have explored representation learning for this task, the critical challenge of training instability in sequential representations and its detrimental impact on policy performance has been overlooked. This work demonstrates that Controlled Differential Equations (CDE) state representation can achieve strong RL policies when two key factors are met: (1) ensuring training stability through early stopping or stabilization methods, and (2) enforcing acuity-aware representations by correlation regularization with clinical scores (SOFA, SAPS-II, OASIS). Experiments on the MIMIC-III sepsis cohort reveal that stable CDE autoencoder produces representations strongly correlated with acuity scores and enables RL policies with superior performance (WIS return $> 0.9$). In contrast, unstable CDE representation leads to degraded representations and policy failure (WIS return $\sim$ 0). Visualizations of the latent space show that stable CDEs not only separate survivor and non-survivor trajectories but also reveal clear acuity score gradients, whereas unstable training fails to capture either pattern. These findings highlight practical guidelines for using CDEs to encode irregular medical time series in clinical RL, emphasizing the need for training stability in sequential representation learning.