Primary Sclerosing Cholangitis with Cholelithiasis Is a Distinct Phenotype with Worse Symptoms, Decompensation-Free & Transplant-Free Survival
Bibliographic record
Abstract
Introduction: Classically, the presence of cholelithiasis favors a diagnosis of secondary rather than primary sclerosing cholangitis (PSC), but up to 8% of patients with PSC may have cholelithiasis. Our aim was to determine whether PSC patients with and without cholelithiasis are distinct entities with different outcomes.Figure 1Methods: A retrospective cohort study was conducted with adults with large-duct PSC. Cholelithiasis & disease distribution were determined with baseline & follow-up imaging. Cox regression was used to determine predictors of poor composite outcome (decompensation, liver-related death or transplant). Results: 112/198 charts were included (67 no cholelithiasis [NCL]; 45 cholelithiasis [CL]). Less women had CL (p=.005); there were no other differences in baseline parameters (ie. disease distribution (p=.54), inflammatory bowel disease (IBD) (p=.89), type of IBD (p=.53). Over 50% of patients with cholelithiasis had right sided disease. By the end, the CL group was more likely to be cirrhotic (62% vs 42%, p=.03), worse symptoms (jaundice, fatigue, pruritus, cholangitis), and two-fold higher alkaline phosphatase (ALP) and transaminases (AST and ALT). 18% of the CL group required 2 or more ERCPs, compared to only 5% of the NCL group (p=.02). Both had similar rates of hepatobiliary cancer (p =.73). Cholelithiasis independently predicted worse outcome (HR 2.6, 95%CI 1.3-5.4, p= 0.008), after adjusting for age at diagnosis, baseline cirrhosis & ALP. Adjusting models for sex, ethnicity and cumulative use of ursodeoxycholic acid (UDCA) resulted in similar hazard ratios for cholelithiasis. Conclusion: PSC with cholethiasis is a distinct phenotype of PSC, with worse symptoms and composite outcome. The presence of cholethiasis may partly explain the variability in the natural history of PSC across different studies. Modification of bile lithogenicity with therapies such as UDCA may alter symptom profile and prognosis in certain patients with PSC.
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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 | 0.001 |
| 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) | 0.004 | 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".