A322 ALBUMIN MODIFIED BODY MASS INDEX FOR THE ASSESSMENT OF CIRRHOTIC PATIENTS UNDERGOING ORTHOTOPIC LIVER TRANSPLANT
Bibliographic record
Abstract
Body Mass Index [BMI: weight(kg)/height(m)2] has been previously identified a key predictor of mortality in orthotopic liver transplant (OLT) recipients. However, the interpretation of BMI in subjects with cirrhosis is rather controversial due to ascites/anasarca-induced errors. Albumin modified BMI (amBMI= BMI*albumin/40) is an alternative parameter that corrects BMI for potential third spacing in patients with significant hypoalbuminemia. To compare the 5yrs-mortality prediction and discriminatory value of amBMI vs. traditional BMI in cirrhotic subjects undergoing OLT. This single center retrospective cohort study included subjects undergoing OLT at the University of Alberta between 2002–2012. Clinical information was extracted from a dedicated computerized database (OTTR) and audited. The primary outcome was all-cause mortality and/or graft failure at 5 years. Bland-Altman plots and linear correlation between methods were estimated. Prediction models were constructed using Cox proportional hazard regression techniques. Change in models performance using BMI and amBMI was evaluated. Models assumptions and discrimination capacity were tested. Ethics approval was obtained from the local ethics board. A cohort of 524 patients (mean follow-up time 3.1y and 130 (24.9%) events) was assembled. Baseline characteristics include (median[IQR]): age 54[48–59]y, male sex 68%, MELD-score 15[11–23], BMI 25 [23–28], serum albumin 34[30–39]g/L and amBMI 21[18–25]. Cirrhosis aetiologies included HCV(24%), HCC(21%), cholestasis(18%), alcohol(13%) and NASH(8%). Correlation between BMI and amBMI was 71%, (p<0.0001) linear regression and Bland-Altman plots are presented in figures A and B. BMI categories classification concordance between methods was 34%. in 47% of cases amBMI corresponds to a lower BMI category compared to conventional BMI. Compared to conventional BMI, amBMI classified more patients as Underweight ([BMI<18.5] 31 vs 5%, p<0.01) or Severely Underweight ([BMI<16], 14 vs. 0.6%, p<0.001). Despite the significant change in BMI assessment with the two methods, substitution of BMI by amBMI in current survival prediction models did not improve the accuracy nor discrimination capacity of the models. (C2= 21.5, p=0.0007, C-index 0.61 with amBMI vs. C2= 26.2, p=0.0001, C-index 0.63 with BMI). Anthropometric nutritional assessment of patients with cirrhosis can be challenging due to third spacing induced error. amBMI can differ significantly from BMI in this population and may provide an alternative parameter to assess health status and nutrition in this patients. In our OLT cohort, using amBMI instead of conventional BMI did not improve the discriminatory capacity of current models to predict mortality. CAGAlberta Innovates Health Solutions (AIHS)
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 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) | 0.002 | 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".