A192 PRIMARY SCLEROSING CHOLANGITIS WITH CHOLELITHIASIS IS A DISTINCT PHENOTYPE WITH WORSE SYMPTOMS, DECOMPENSATION-FREE & TRANSPLANT-FREE SURVIVAL
Bibliographic record
Abstract
Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic biliary tree which can lead to cirrhosis and transplant after a median of 18 years. Approximately 26%-38% of patients with PSC may have cholelithiasis but classically, the presence of cholelithiasis favors a diagnosis of secondary rather than PSC.There is scant and conflicting data on the effect of biliary calculi on the clinical presentation and outcomes in PSC. To determine if PSC patients with and without cholelithiasis are distinct entities characterized by differences in epidemiology, presentation, biochemistry, and differences in outcomes (ie. cirrhosis, decompensation, death or transplant). A retrospective cohort study included patients with large-duct PSC from January 1990 to February 2016 at the Toronto Center for Liver Disease, Canada. Cholelithiasis & disease distribution were determined with baseline & follow-up imaging. Differences in continuous and categorical variables were evaluated with Students t-test and chi-square test, respectively. Cox regression was used to determine predictors of poor composite outcome (decompensation, liver-related death or transplant). 169/198 charts were included (126 no cholelithiasis [NCL]; 43 cholelithiasis [CL]). Less women had CL (p=.03); there were no other differences in baseline parameters (ie. disease distribution (p=.76), IgG4 level (p=.27), inflammatory bowel disease (IBD) (p=.76), type of IBD (p=.0.49). By the end, the CL group was more likely to be cirrhotic (65% vs 43%, p=.02), with intermediate/high Mayo Risk Scores (64% vs 36%, p=.04) & worse symptoms (jaundice, fatigue, pruritus, cholangitis), & worse outcome (p=.007), but similar rates of hepatobiliary cancer. The presence of cholelithiasis was an independent predictor of the composite outcome of decompensation, liver-related death or transplant when adjusting for a) age, cirrhosis, & ALP (HR 2.45, 95%CI 1.17–5.13, p=.02) and b) sex, ethnicity & ursodeoxycholic acid (UDCA) use (similar HRs). The presence of cholethiasis may partly explain the variability in the natural history of PSC across different studies. Modification of bile lithogenicity with therapies such as UDCA may alter symptom profile and prognosis in certain patients with PSC. None
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".