Abstract
<jats:p>Background Clinical data analysis typically requires statistical programming skills, whereas cloud-based artificial intelligence (AI) agents risk exposing sensitive patient records. We developed and functionally validated a privacy-preserving, zero-code conversational statistical analysis framework that translates natural-language clinical research requests into executable R workflows while strictly retaining raw patient data within local computing environments. Methods Orchestrated by the n8n engine, the system integrates the DeepSeek-Reasoner model with a Pinecone vector database for retrieval-augmented generation (RAG), grounding statistical selection in curated biostatistical guidance and R templates. Core functionalities include data schema perception, interactive data cleaning, requirements refinement, and local R code execution via a controlled command-line interface. System performance was evaluated by replicating a published prognostic model study on metabolic dysfunction-associated steatotic liver disease (MASLD). Findings All core analytical workflows, including data cleaning, multivariable Cox proportional hazards modeling, model diagnostics, and publication-ready tables and figures (e.g., baseline characteristics, Schoenfeld residuals, receiver operating characteristic curves, and forest plots), were executed solely through natural-language dialogues without manual coding. The external large language model actively clarified analytical prompts while receiving zero row-level patient data. Interpretation Decoupling remote cloud reasoning from local code execution lowers the technical threshold for clinicians conducting data-driven research while safeguarding data privacy. This architecture provides a practical, scalable, and reproducible framework for converting natural-language clinical questions into executable statistical workflows. Funding National Natural Science Foundation of China (82473291), Shaanxi Province "Three Qin Scholars" Innovation Team Project (2023001), and Fundamental Research Funds for the Central Universities (xtr062023003).</jats:p>