Bibliographic record
Abstract
The hepatopulmonary syndrome (HPS) is a rare condition defined as the triad of cirrhosis, intrapulmonary vascular dilatations (IPVDs), and abnormal gas-exchange. Recently, there has been controversy in the scientific literature regarding the criterion for abnormal gas-exchange that should be used in this syndromic definition. Although current expert recommendations call for an alveolar-arterial oxygen gradient cutoff of >20 mm Hg (a low threshold cutoff), other authors have suggested higher threshold cutoffs. In our clinical experience, we have noted significant variability in the alveolar-arterial oxygen gradient over time among patients with possible HPS. Our objectives were to characterize and formally describe this variability in order to propose a new, more stable diagnostic cutoff. We analyzed longitudinal gas-exchange data over five years from 58 patients who were referred to the Toronto HPS Clinic. Each patient had an average of 4.19 visits on file. Using the expert recommended cutoffs, we found that 20.69% of patients fluctuate above or below the threshold for abnormal gas-exchange despite stability of clinical symptoms. Using a stricter two-visit partial pressure of arterial oxygen cutoff of <80mm Hg, no patients fluctuate above or below the cutoff. The stricter cutoff also has stronger correlations with clinical indicators of disease progress and severity. The currently recommended cutoffs for abnormal gas-exchange in HPS patients may not be the best threshold to establish a stable diagnosis and distinguish patients with respect to disease progress and severity.
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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 | 0.007 |
| 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) | 0.001 | 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".