P: 16 Traditional Prognostic Tools are Superior to Cognitive Testing and Stool Frequency as Predictors of Poor Outcomes in Cirrhotic Patients Admitted with Hepatic Encephalopathy
Bibliographic record
Abstract
BACKGROUND: Model for end-stage liver disease-sodium (MELD-Na) score and extrahepatic organ failures (EHOFs) predict poor outcomes in cirrhotic patients, including those with hepatic encephalopathy (HE); however, there is a need for the development of additional and specific predictors for outcomes in HE. We aimed to determine if cognitive testing, total daily lactulose dose (TDLD), and stool frequency at hospital discharge predicts readmission and other poor outcomes in patients admitted with overt HE. METHODS: We performed a prospective study of patients admitted to a single transplant center with overt HE. When the primary team anticipated discharge within 48 hours, consented subjects underwent Psychometric HE Score (PHES), Montreal Cognitive Assessment (MOCA), liver frailty index (LFI), and stool frequency assessment. MELD-Na, EHOFs, and other clinical variables were assessed via chart review. At 30 days post-discharge, subjects were called to evaluate for a composite primary outcome of HE readmission, transition to hospice, liver transplantation, or death. T-test or chi-square test compared predictors between those who did and did not meet the primary endpoint. RESULTS: Of 175 potential candidates, 52 patients provided informed consent and enrolled, with the majority (82) of patients excluded for discharge, death, transplant, or transfer to hospice before enrollment could be performed. Within 30 days, 7 patients had a readmission for HE, and 11 died, were transplanted or transferred to hospice. Seventeen patients met the primary composite endpoint. MELD-Na (28.1 ± 8.0 vs. 22.0 ± 6.0, P = .01) and the number of EHOFs (1.3 ± 1.3 vs. 0.5 ± 0.8, P = 0.03) were higher in patients who met the primary composite outcome. Most predictors did not vary between those who met and did not meet the primary endpoint, including MOCA score ( P = 0.73), PHES ( P = 0.97), stool frequency ( P = 0.34), total daily lactulose dose ( P = 0.80), LFI ( P = 0.57), admission ammonia ( P = 0.58), or being discharged on rifaximin ( P = 0.70). Stool frequency at discharge did not correlate with PHES ( P = 0.71) or MOCA score ( P = 0.51). CONCLUSIONS: Traditional prognostic tools in cirrhosis, including MELD-Na and EHOF, were superior to cognitive assessments, total daily lactulose dose, and stool frequency in predicting 30-day outcomes for those admitted with overt HE. Future studies should evaluate MELD-Na and the presence of EHOFs as determinants of discharge readiness or discharge destination in patients admitted with cirrhosis and HE.
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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 | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 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".