A327 OPTIMAL TIMING OF BILIARY DRAINAGE IN SEVERE ASCENDING CHOLANGITIS
Bibliographic record
Abstract
Optimal timing of biliary drainage in ascending cholangitis (AC) is unclear. Early drainage is recommended in moderate and severe AC cases. However, demonstrable benefit in mortality and morbidity outcomes based on timing of biliary drainage is lacking. To investigate if the time to biliary drainage provides benefit in mortality and morbidity outcomes in severe AC. We completed an updated retrospective database analysis and chart review of ICU admitted AC cases between 2000 and 2014. This was completed using the University of Manitoba Adult ICU Database and manual chart review of flagged ICU admitted cholangitis cases in order to verify the diagnosis and assess clinical outcomes. Statistical analysis has included creation of linear and logistic regression models and survival analysis for mortality and length of stay. In total, 198 cases were flagged in the database. After chart review, 114 cases of AC were identified in 113 patients. The population mean age was 72 (SD 13.5), gender was 44% female, and mean APACHE II score was 22.3 (SD 8.0). The majority of cases (79%) were managed predominantly in tertiary care hospitals compared with community ICUs (21%). The mean time to biliary drainage was 49 hours (SD 56.0) and 16 cases did not undergo biliary drainage (14 of whom died). Mean length of hospital stay was 32.7 days (SD 76.7). In unadjusted logistic regression, biliary drainage was associated with significantly reduced odds of mortality (OR 0.11, p = 0.007, 95% CI 0.02 – 0.55). Logistic regression of time to biliary drainage, when controlling for APACHE score, did not appear to be associated with death (OR 1.0, p = 0.82). Survival analysis predicting length of stay in hospital by time to biliary drainage, though not statistically significant, suggested a possibly reduced hazard rate for those groups that were drained between 15–69 hours (HR .56, p = 0.24) and 70+ hours (.49, p = .24) compared with those drained in less than 15 hours. In severe AC, biliary drainage may be associated with reduced mortality; however, time to biliary drainage in this analysis has not demonstrated to be associated with altered mortality. Early biliary drainage showed a non-significant trend toward shorter hospital length of stay. Rigorous competing risks analysis is ongoing to assess for confounders and to investigate the associations between these and other health related outcomes. 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 | 0.001 | 0.006 |
| 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".