P268 Fecal calprotectin correlates more highly with endoscopic disease activity than symptom-based disease activity markers in paediatric PSC-IBD
Bibliographic record
Abstract
Background: Inflammatory bowel disease (IBD) with primary sclerosing cholangitis (PSC) has a distinct phenotype, with mild symptoms despite pancolitis and frequent backwash ileitis. The well-known greater risk of colonic neoplasia (where chronic inflammatory activity is a risk factor) led us to hypothesize that symptoms might be an inaccurate reflection of endoscopic disease activity in children with PSC-IBD. Methods: In this single-centre prospective study, Paediatric UC Activity Index (PUCAI), physician global assessment (PGA) and fecal calprotectin (FC) were measured in all PSC-IBD patients undergoing colonoscopy. Patients with colonic IBD without PSC served as controls. Colonoscopies were scored by two blinded IBD physicians using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and endoscopic PGA. Spearman correlations were calculated between variables. PUCAI and FC were compared between patients in and not in endoscopic remission (UCEIS 0–2), in both groups. Results: 24 PSC-IBD and 32 colonic IBD patients were enrolled (Table 1). Median PUCAI and FC at colonoscopy were 2.5 (range 0–70) and 348 (37–8252) μg/g in PSC-IBD patients, and 15 (range 0–75) and 1435 (range 29–16782) μg/g in colonic IBD patients, respectively. As hypothesized, the correlations between symptom-based assessments of disease activity and endoscopy were poor in PSC-IBD patients (r=0.421 for PUCAI, r=0.196 for clinical PGA vs. UCEIS) (Table 2). The correlation between FC and UCEIS was significantly better (r=0.782). FC correlated poorly with both PUCAI and clinical PGA. In contrast, PUCAI correlated well with UCEIS in controls (r=0.824); this correlation was superior to that of FC vs. UCEIS (r=0.696). The correlation between PUCAI and FC was better in controls than in PSC-IBD patients (r=0.525 vs. 0.367). FC and PUCAI differed significantly based on endoscopic remission status in controls, but only FC differed in PSC-IBD patients (Table 1). Table 1. Patient and disease characteristics Table 2. Spearman correlations between symptom-, biomarker- and endoscopy-based markers of disease activity in paediatric PSC-IBD Conclusions: Absence of symptoms cannot be relied on to reflect endoscopic activity in paediatric PSC-IBD. FC appears to be more accurate in this setting. Given the emerging importance of the gut-liver axis in PSC, increasing attention must be paid to achieving mucosal healing, particularly in children in early phases of PSC, where the possibility of altering biliary disease progression may be greatest.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".