Letter: acute severe ulcerative colitis - should all patients be treated equally? Authors' reply
Bibliographic record
Abstract
We would like to thank Barreiro-de Acosta and Gisbert for their interest in our article.1, 2 The mortality we observed in the elderly acute severe ulcerative colitis (ASUC) population was striking, with a 13-fold and 28-fold increased risk of death in those patients over 60 in 2008 and 2010 respectively.2 This higher mortality in the elderly has been previously reported and was recently summarised in a review of mortality in ulcerative colitis (UC).3 In addition, our finding of increasing mortality in patients with comorbidities might go some way in explaining the higher mortality in elderly patients. It is of note, however, that age and comorbidity have previously been shown to be independent risk factors for mortality in UC.4 A recent report by Charpentier et al. suggests that elderly UC patients' presentations are phenotypically different, with milder disease at presentation, but with earlier progression to colectomy when compared with younger patients;5 could this be relevant in the increased mortality observed? As patients survive longer and present with evermore complex comorbidities, these findings will certainly be relevant in future ASUC management. We would also agree that it is important to at least consider medical rescue therapy in all ASUC patients failing steroid therapy as we have not demonstrated increased short-term mortality when compared with surgery.2 Similar to Nørgård et al.,6 we have demonstrated, in unpublished work from this cohort, that there is no increase in short-term complications in patients who undergo surgery following rescue medical therapy.7 However, it is important to emphasise that our follow-up extends only to hospital discharge. The cornerstone of high-quality care in ASUC continues to be a multidisciplinary approach, with decisions being made promptly and with the appropriate involvement of all members, including patients. The authors' declarations of personal and financial interests are unchanged from those in the original article.2
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.005 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.031 | 0.034 |
| Insufficient payload (model declined to judge) | 0.007 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".