S1152 Emergency Department Utilization in Patients With Hepatic Encephalopathy (HE) Treated With Rifaximin (± Lactulose) versus Lactulose Alone
Bibliographic record
Abstract
Introduction: Prophylaxis is advocated for preventing HE recurrence in patients (pts) with a history of overt HE. Rifaximin is indicated for reduction in risk of overt HE recurrence in adults. We hypothesized that treatment with rifaximin ± lactulose would be associated with lower rates of emergency department (ED) visits vs treatment with lactulose alone. Methods: Analyses were done using 2 US commercial claim databases: IBM® MarketScan® Commercial Database (Jul 1, 2014–Jun 30, 2019) and Optum’s de-identified Clinformatics® Data Mart Database (Jul 1, 2014–Mar 31, 2020). Pts with HE treated with rifaximin 550 mg (regardless of tablets/d; ± lactulose) or lactulose alone were identified via algorithm developed with clinical experts. Analysis included pts aged 18–64 y at index date (first prescription fill), with ≥6 mo of continuous enrollment before and ≥30 d after index date. Treatment episodes for each pt were defined based on current/recent exposure and classified as rifaximin (± lactulose) or lactulose only. The analysis focused on treatment episodes with high adherence (proportion of days covered [PDC] ≥80%; calculated at episode level, with PDC defined as the sum of days with treatment on hand divided by duration of treatment episode). Lactulose mean daily dose for PDC was conservatively assumed to be 15 mL/d (per clinical expert input). Differences between rifaximin (± lactulose) and lactulose treatment episodes were compared using an incident risk ratio (IRR), adjusted for potential confounding factors. Results: 7675 pts from the MarketScan database were included, contributing 9632 rifaximin- and 4348 lactulose-adherent episodes. In the Optum database, 3530 pts were identified (rifaximin adherent episodes, n = 3680; lactulose, n = 2103). The mean ± SD duration of follow-up in the 2 databases was 14.5 ± 12.6 mo and 13.9 ± 13.1 mo, respectively. For the MarketScan database, there was a 25% decrease in the number of days with ED services used when comparing rifaximin vs lactulose treatment-adherent episodes (adjusted IRR, 0.75; 95% CI, 0.68–0.83; P < 0.001). For the Optum database, there was an 18% decrease in the number of days with ED services used when comparing rifaximin vs lactulose treatment-adherent episodes (adjusted IRR, 0.82; 95% CI, 0.73–0.93; P = 0.002). Conclusion: These real-world data indicate that treatment with rifaximin (± lactulose) in pts at risk for HE may reduce ED healthcare utilization vs treatment with lactulose alone.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 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".