Parallel 17: Hepatitis B: Prevention, Natural History, and Outcomes
Bibliographic record
Abstract
Background: HBV infection is frequent world-wide and may result in progressive liver disease or HCC.Effective therapies are available but treatment is usually reserved for patients (pts) with selected biochemical and serological profiles (phenotypes).Currently, criteria for defining HBV phenotype are not standardized and are based upon expert opinion rather than medical evidence.Aim: To determine the distribution of phenotypes in a large cohort of North American pts with chronic HBV infection using standardized definitions and calculation.Methods: Epidemiologic, demographic, biochemical and virologic features of pts enrolled into the HBRN Cohort Study at 19 US and 1 Canadian site were analyzed, assigning pts into 1 of 4 phenotypes: immune tolerant (IT), chronic hepatitis B with (CHB e+) or without HBeAg (CHB e-) or inactive carrier (IC) based upon baseline HBV DNA and ALTs.Cut-off HBV DNA values used to define phenotypes were 10 4 IU/ml for e-negative and 10 5 for e-positive pts.ALT cut-offs were analyzed using either fixed values (30 U/L for men, 20 U/L for women) or using each local lab ULN.Pts not fitting into a phenotype were designated "Indeterminant".Independently, local investigators assigned a phenotype at baseline based on available laboratory values and clinical impression.Results: 1398 adults (51% male, 71% Asian) had data needed to determine phenotype.The table shows the distribution of phenotypes calculated by two methods of assessing ALT and physician assessment.Only moderate agreement was found between clinician-determined and calculated phenotype using fixed ALTs (Kappa 0.39, 95% CI 0.36-0.42).Of note, only 13% of pts were designated Indeterminant by clinicians compared to 20-40% by computer calculation.Using the Fixed ALT groups for comparison, IT was most distinct, being generally younger, more frequently Asian and female.The most frequent clinical phenotype identified was Indeterminant, the majority of whom (83%) had elevated ALT values despite low levels of HBV DNA, not apparently associated with higher BMI, alcohol consumption or HBV genotype.Clinician estimates often differed from the calculated phenotype.Conclusions: The clinical significance of HBV phenotypes using these standardized definitions requires further study based on long term follow up of these patient cohorts but there is clearly a need to re-examine categorization of pts with chronic HBV infection to more accurately predict their outcomes and need for therapy.
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.019 | 0.002 |
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".