250.5: Early Predictors of Enteral Autonomy in Pediatric Intestinal Failure:Development of a Disease Severity Score
Bibliographic record
Abstract
Introduction: Patients with short bowel syndrome (SBS) are dependent on parenteral nutrition (PN) while their bowel attempts to compensate for loss of function. Our objective was to create a SBS disease severity score that would predict the probability of achieving enteral autonomy (EA) using clinical variables available in the early postoperative period. Methods: A retrospective cohort study of SBS children managed by our Intestinal Rehabilitation Program (IRP) was completed. Data abstracted included demographic, anatomic and outcome variables including serum conjugated bilirubin, proportion of enteral nutrition (EN) and episodes of sepsis specifically at 6 months post gut loss. A univariate analysis and Cox proportional hazards (CPH) model was performed. A score predicting EA was created based on weighting of Cox model coefficients. For all analyses, an alpha-value of <0.05 was considered significant. Results: 139 patients were analyzed (61% males). Ninety-five (68%) achieved EA. Those who achieved EA had a longer residual small bowel (75% vs 24%; p<0.0001) and colon (100% vs 75%; p<0.0001) and were less likely to have the ileocecal valve removed (26% vs 57%; p=0.0005). At 6 months, children who achieved EA had higher enteral tolerance (100% vs 30%; p<0.0001), a lower conjugated bilirubin (0 vs 71.5umol/L; p<0.0001) and less septic episodes (1.0 vs 2.0; p=0.0112). Cox proportional hazards modeling found >50% residual small bowel (HR 2.68 [95%CI 1.60–4.49], p<0.001), ICV intact (HR 0.61 [95%CI 0.37–1.02], p<0.06) and >50% enteral tolerance at 6 months (HR 5.70 [95% CI 2.77–11.74] p<0.001) were positively associated with EA. Conjugated bilirubin >34umol/L at 6 months was negatively associated with EA (HR 0.42 [95%CI 0.27–0.66], p<0.001). A severity score was created by weighting CPH parameter estimates [small bowel length >50%, ICV intact, CB<34umol/L and EN>50% for a maximum score of 8. Disease severity strata were developed (severe [0–2; 25.7% EA], moderate [3–5; 52.9% EA] and mild [6–8; 97.1% EA]. Disease severity strata were developed (severe [0–2; 9/35 (25.7%) EA], moderate [3–5; 18/34 (52.9%) EA and mild [6–8; 68/70 (97.1%) EA]. Conclusion: We propose a paediatric intestinal failure disease severity score that predicts probability of EA, stratified into mild, moderate and severe. The score allows prognostication of individual patients, and could assist research by adjusting outcome reporting or stratifying recruitment.
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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 | 0.003 |
| 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 | 0.000 | 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".