A60 PREDICTIVE FACTORS OF INTENSIVE CARE UNIT ADMISSION AND MORTALITY IN CIRRHOTIC PATIENTS WITH UPPER GASTROINTESTINAL BLEEDS
Bibliographic record
Abstract
Acute upper gastrointestinal bleeds (UGIB) are the most common emergency condition managed by gastroenterologists in the emergency department. Several pre-endoscopic scoring systems have been developed to predict clinical outcomes in patients presenting with UGIB, however these have not been validated in predicting outcomes in UGIB in cirrhotic patients. The objective of this study is to elucidate patient factors at presentation that are associated with admission to the intensive care unit (ICU) or mortality in cirrhotic patients presenting with UGIB. All patients over the age of 18 with known cirrhosis presenting with a first presentation of UGIB were eligible for inclusion into this study. A sequential retrospective analysis of patients presenting to The Ottawa Hospital between 2014 and 2016 was performed to collect baseline characteristics at admission including demographics, etiology and complications of cirrhosis, vital signs, blood work, model of end stage liver disease (MELD) score, active alcohol or intravenous drug use, length of stay, transfusion requirement. Patients were stratified by need for ICU or mortality. Descriptive statistics were calculated using chi-square and t-test with R v3.3. A total of 117 patients with cirrhosis presenting with an UGIB were included, 31 of which were admitted to the ICU or died during admission and comprised the ICU/death group. There were no significant differences between baseline characteristics including age, gender, cirrhosis etiology, and active alcohol or current injection drug use. The presence of variceal bleeding was similar was similar between groups (ICU/death: 74.2% vs 60.5%, P=0.172). At admission, the ICU/death group had lower systolic blood pressure (108.5 vs 120.5, P=0.004), higher white blood cell count (12.9 vs 7.9, P=0.006), higher INR (1.7 vs 1.4, P<0.001), higher bilirubin (62.0 vs 27.0, P=0.001), lower albumin (23.0 vs. 26.0, P=0.001) and a higher MELD score (18.14 vs 13.43, P<0.001). The proportion of patients requiring blood transfusion was higher in those with ICU/death (87.1% vs 52.3%, P=0.001). Hospital length of stay was also longer in this group (6.9 vs 4.8 days, P=0.028). Among cirrhotic patients presenting with UGIB, the presence of impaired synthetic liver function and elevated MELD score is associated with more severe outcomes and predictive of the need for ICU admission and in hospital death. 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 | 0.003 |
| 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".