Abstract 9948: Serum Total Bilirubin Levels Predict Amputation Events in Type 2 Diabetic Mellitus
Bibliographic record
Abstract
Objectives: Bilirubin is well known for its antioxidant and anti-inflammatory properties, and may protect against vascular disease. It has previously been demonstrated that higher serum bilirubin levels were associated with reduced peripheral arterial disease (PAD) prevalence. However, the relationship between bilirubin and lower limb amputation, a consequence of PAD, is currently unknown. We hypothesized that bilirubin protects against amputation events in type 2 diabetic patients with PAD. Methods: The relationship between baseline serum total bilirubin level and amputation events was analyzed in 9795 type 2 diabetic patients from the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study in a pre-specified subsidiary analysis. Lower limb amputation was adjudicated blinded to treatment allocation. Relevant clinical and biochemical data were available for analyses. Bilirubin was analyzed continuously using Cox regression techniques. Results: Serum bilirubin level was significantly inversely associated with lower limb amputation rate. When bilirubin was analyzed continuously, patients with lower bilirubin levels had an increased risk of amputation compared with patients with higher bilirubin levels (HR 1.38 per 5 µmol/L decrease in bilirubin, 95% CI 1.07-1.79, p=0.013). The same association persisted after adjustment for baseline variables including age, sex, height, smoking status, alcohol intake, GGT, ALT, HbA1c, and history of hypertension, hypercholesterolemia, previous PAD, prior revascularization, amputation, ulcer, neuropathy, renal dysfunction and diabetic retinopathy (p=0.032), as well as treatment allocation (placebo vs. fenofibrate). Conclusion: Our results identify a highly significant inverse relationship between serum bilirubin level and lower limb amputation rate. Our data is consistent with the hypothesis that bilirubin plays a protective role against amputation in the setting of type 2 diabetes.
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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 | 0.001 |
| 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".