Letter: is blood transfusion really a risk factor for rebleeding in nonvariceal gastrointestinal bleeding? Authors’ reply
Bibliographic record
Abstract
We thank Dr Lin for his comments1 and the opportunity to emphasise important aspects of our recently published analysis.2, 3 In fact, we indeed performed thorough multivariable risk adjustment for all of factors listed by Dr Lin. We adjusted for blood on rectal examination or in the nasogastric tube aspirate, ASA score, co-morbidities, haemodynamic instability, initial haemoglobin, use of fresh frozen plasma, red blood cell transfusion, presence of high risk endoscopic stigmata, performance of endoscopic therapy and proton pump inhibitor use. We included all parameters found in the Blatchford scale except for urea,4 as the data used in this analysis were also used to validate a modified Blatchford scale that excludes urea.5 Our results, and those of a large UK audit,6 suggest that transfusion practice, and more specifically blood administration in the first 24 h, may independently predict poorer outcomes. This observation was recently validated in a large randomized trial of patients with upper gastrointestinal bleeding, and more specifically amongst class A and B cirrhotic patients.7 Unfortunately, issues of generalisability in the aforementioned trial prevent definitive conclusions about the impact of transfusion policy on the outcomes of patients with nonvariceal bleeding; importantly, additional information will soon be available from a cluster randomized trial in the United Kingdom.8 In the interim, based on all currently available evidence, clinicians should continue to follow consensus recommendations for patients with nonvariceal bleeding. We would also like to correct Dr Lin regarding his comments about current recommendations. The 2010 International Consensus Group in fact suggested a restrictive transfusion practice, with blood transfusions administered to patients with a haemoglobin level of 7 g/dL or less, pending further data.8 Furthermore, threshold haemoglobin levels of 6–10 g/dL may warrant transfusion in patients with underlying cardiac disease.9 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 | 0.005 | 0.055 |
| 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 | 0.003 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.027 | 0.029 |
| Insufficient payload (model declined to judge) | 0.008 | 0.007 |
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".