A186 HEPATIC STEATOSIS PREDICTS FIBROSIS IN LONG-TERM METHOTREXATE USE
Bibliographic record
Abstract
Abstract Background Methotrexate (MTX) is effective for dermatologic and rheumatologic conditions such as psoriasis (Ps), psoriatic arthritis (PsO) and rheumatoid arthritis (RA). Long-term MTX use may be complicated by hepatic fibrosis, although patient, disease factors and the mechanism remain unclear. Transient elastography (TE) is a non-invasive measure of hepatic fibrosis that is often used as surveillance in this patient population. Patients with Ps and PsO have higher rates of non-alcoholic fatty liver disease. The controlled attenuation parameter (CAP) measurement is a non-invasive test that correlates with histologic degree of steatosis. To our knowledge, no studies have evaluated hepatic steatosis via CAP scores in MTX use. Aims To determine the prevalence of steatosis and significant fibrosis (F≥stage 2) in persons on MTX therapy and to determine the predictive factors for these events. Methods A single centred retrospective cohort study was performed. Patients on >6 months of MTX for a dermatologic or rheumatologic disease who had undergone TE from January 2015 to September 2019 were included. Demographic variables, laboratory investigations, TE and CAP scores were collected. Multivariate analysis was performed to determine predictors of steatosis and fibrosis. Results A total of 177 patients on methotrexate were included. Ps was the most frequent diagnosis (n=52) followed by RA (n=50) and PsO (n=38). Steatosis (CAP≥245 dB/m) was present in 73.9% of patients. Patients with steatosis had significantly more fibrosis and a higher BMI than those without steatosis (CAP<245 dB/m). Higher CAP score was correlated with increased lifetime dose of methotrexate by Pearson correlation analysis (r=0.48, p=0.001) (n=85 patients). Multivariate regression analysis revealed that diabetes mellitus (OR 10.5, 95% CI 1.38–80.60), hypertension (OR 4.97, 95% CI 1.66–14.84), and BMI> 30 (OR 10.1, 95% CI 1.88–37.14) were predictors of steatosis (CAP≥245 dB/m). Predictors of METAVIR≥F2 (TE≥8.0 kPa) by multivariate regression analysis included CAP score of ≥270 (OR 8.36, 95% CI 1.88–37.14), diabetes mellitus (OR 2.85, 95% CI 1.09–7.48), hypertension (OR 5.4, 95% CI 2.23–13.0), dyslipidemia (OR 3.71, 95% CI 1.50–9.18) and alcohol use (OR 3.06, 95% CI 1.2–7.49). Conclusions In patients on MTX for rheumatologic and dermatologic diseases, hepatic steatosis was common and predicted significant fibrosis. Additionally, increasing MTX exposure is correlated with steatosis. Features of the metabolic syndrome including diabetes, hypertension or obesity were predictors of both steatosis and fibrosis (F≥2). Further study is needed to evaluate if steatosis is a mechanism by which fibrosis occurs in patients on MTX, or if it due to other patient factors. Funding Agencies None
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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 | 0.002 |
| 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 | 0.000 | 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".