Identification of the Predictive Factors of Primary Sclerosing Cholangitis in Patients with Inflammatory Bowel Disease
Bibliographic record
Abstract
Introduction: Primary sclerosing cholangitis (PSC) is associated with inflammatory bowel disease (IBD), ulcerative colitis (UC) in particular. Due to the potential serious complications of this condition, there is a need to identify predictors of disease development. This study attempts to identify the relationship between the levels of several serological markers and the development of PSC in IBD patients. Methods: A case-control study was conducted at the Royal Victoria Hospital between 2013 and 2015. Cases were defined as patients already known for any IBD who were diagnosed with PSC without any other concomitant liver disease. Controls were defined as patients with IBD and no known liver disease. Predating the diagnosis of PSC, serologic levels of alkaline phosphatase (ALP), alanine and aspartate aminotransferases (ALT & AST), gamma glutamyl transpeptidase (GGT), anti-neutrophil cytoplasmic antibody, anti-nuclear antibody, anti-smooth muscle antibody, anti-mitochondrial antibody, immunoglobulins (IgG, IgA and IgM), and anti-liver kidney mitochondrial antibodies were recorded. Patients were excluded if the serological markers were measured after the diagnosis of PSC. Patients were matched based on gender, location, type and subtype of their IBD according to the Montreal Classifi cation. Results: A total of 148 patients, 37 cases and 111 controls were included. The mean age was 46.2 vs 45.8 for cases vs controls. Overall, a diagnosis of UC was more common in cases than controls (57% vs. 39%). Patients in the case group were more likely to have high ALT, AST, ALP, and GGT. Means of liver enzymes were higher in cases than controls (ALT 47.3 vs. 23.0 U/L, AST 42.1 vs. 22.8 U/L, ALP 156.7 vs. 68.5 U/L, and GGT 115.4 vs. 20.1 U/L). IgG was found to be predictive of developing PSC with an odd's ratio (OR) = 5.83, 95% confidence interval (CI) (2.27-14.99) on multivariate analysis. Furthermore patients who smoked were less likely to have PSC OR = 0.19, 95% CI (0.06-0.58). Similar results were found when stratifying based on IBD type. Patients with UC who were asymptomatic were more likely to have PSC, OR = 3.45, 95% CI (1.33-8.93), while those with rectal bleeding were less likely, OR = 0.13, 95% CI (0.03-0.62). Conclusion: Our study demonstrated that high IgG level is predictive of developing PSC in patients with IBD while smoking is protective. In addition, PSC was shown to develop in patients with quiescent disease. Further prospective studies are required to further investigate our findings.
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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 | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".