S3409 Assessment of Toronto Criteria for Response to Ursodiol Use Among PBC Patients in a Community Outpatient Setting
Bibliographic record
Abstract
Introduction: Primary biliary cholangitis (PBC) is a chronic autoimmune disorder characterized by portal inflammation and intrahepatic biliary duct destruction. Ursodiol is the first-line treatment for many patients with PBC. Response to ursodiol has been measured by either Toronto criteria, Barcelona criteria, or Paris I criteria, with Toronto criteria being the most commonly used criterion in the United States. Previous studies have assessed the Toronto criteria in tertiary care facilities and might have missed many patient follow-ups. The primary aim of this study is to re-assess the effectiveness of Toronto criteria for measuring the response to ursodiol in a community outpatient clinic with regular patient follow-ups. Methods: A retrospective cohort study was conducted at Liver Associates of Texas Hepatology outpatient clinics in Houston, Texas. All patients diagnosed with PBC from January 2018-May 2021 were included. Lab results before and 1 year after starting ursodiol in these patients were collected from their records. Response to Ursodiol was measured using the Toronto criteria [alkaline phosphatase (ALP)≤1.67 times upper limit of normal (ULN) are responders and ALP >1.67 times ULN are non-responders]. Continuous variables were compared with either the Student’s T-test or Wilcoxon Rank-sum test. Chi-square test, Fisher’s exact test and logistic regression were used for categorical variables. Significance level was set at 5%. Results: Data for ursodiol response was available for 111/136 patients with PBC included in the study. 65/111 (58.6%) were ursodiol responders and 46/111 (41.4%) were ursodiol non-responders. Non-responders were significantly younger than responders. 36.8% were white, 14.7% were Hispanic, 12.5% were African American, 3.7% were Asian, 2.2% were Native American, and 30.2% were of unspecified race. Majority of the patients were female with no significant difference in gender distribution. Creatinine levels (mg/dL) were significantly different after ursodiol use [median: 0.75 vs 0.78, P=0.023] ALP levels significantly improved after ursodiol use [P=0.001]. Conclusion: ALP levels were significantly decreased among ursodiol responders vs non-responders confirming the use of Toronto criteria. In addition, non-responders were significantly younger than responders. Further studies are required to assess causal factors associated with increase in creatinine after ursodiol use.Table 1.: Alkaline Phosphatase and age in Ursodiol responders vs non-responders among PBC (Primary Biliary Cholangitis) patients.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 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) | 0.004 | 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".