P132 Performance of a severity score in risk stratification of patients with ulcerative colitis
Bibliographic record
Abstract
Abstract Background Patient stratification according to the risk of developing complications is an essential step to define the best treatment approach in patients with ulcerative colitis (UC). Recently, Siegel et al (Gut 2017) published a score that aims to access the disease severity, considering disease activity (both clinical and endoscopic factors) and complications during the disease course, ranging from 0 to 100 values (higher values indicating worse disease severity). Our goal was to evaluate the capacity of this score calculated at the time of diagnosis (dx) to predict disease course during follow-up (FU): steroid use, therapy escalation to immunomodulators or biologics, hospitalisation and/or abdominal surgery. Methods Retrospective cohort study including incident cases of UC in our centre between December 2012 and December 2018. We calculated the score at the time of dx and at the end of FU and collected data about disease course. Results Eighty-five patients (57% men with a mean age of 43 ± 17 years) with newly diagnosed UC were included. Disease extension according to Montreal was E1 in 30/85 patients, E2 in 37/85 patients and E3 in 18/85 patients. Median FU time was 40 months. Median risk score at the time of dx was 30 (IQR 3–91) and it was higher in patients with younger age (36 vs. 26, p = 0.08) and extensive colitis (64 vs. 26, p < 0.001). During FU, 19/85 and 17/85 patients needed steroid use and therapy escalation, respectively. Proximal disease extension occurred in one patient. Hospital admission for acute exacerbation and/or colectomy was required in 6/85. The score at dx was higher in patients who underwent hospital admission or colectomy (score: 70 vs. 26, p = 0.002), or that needed steroid (score: 57 vs. 26, p < 0.001) or therapy escalation (score: 57 vs. 26, p < 0.001) during FU. In a survival analysis, the time for steroid use (plogrank < 0.001) or therapy escalation (plogrank < 0.001) was lower in patients with a higher score at dx (61 vs. 88 months and 56 vs. 86 months, respectively). The median score at the end of FU was 3 (IQR 0–66); a second colonoscopy was not available in three patients, who were not included in this analysis. There was a score reduction in 77/82 patients (39/82 had a score of 0). Only one patient had a similar score and 4/85 patients had a higher score. Patients with a significant score reduction during FU (below the median) were more frequently patients with no need for steroid use (p < 0.001) or therapy escalation (p = 0.002). Conclusion This severity score seems to be a promising tool for risk stratification and prognosis determination in patients with UC, and its utility should be validated in prospective studies.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".