P-103 AN ELEVATED BASELINE LEVEL OF ALKALINE PHOSPHATASE, ALANINE AMINOTRANSFERASE, AND ASPARTATE AMINOTRANSFERASE PREDICT A LACK OF BIOCHEMICAL RESPONSE TO UDCA THERAPY AMONG HISPANIC PATIENTS LIVING WITH PRIMARY BILIARY CHOLANGITIS
Bibliographic record
Abstract
Conflict of interest: No Introduction and Objectives: Primary biliary cholangitis (PBC) is a chronic, progressive, autoimmune liver disease characterized by the destruction of the small bile ducts within the liver. Ursodeoxycholic acid (UDCA) is the first-line treatment for PBC, shown to improve liver biochemistry and delay disease progression. However, the response to UDCA therapy is variable among patients, with some failing to achieve a satisfactory biochemical response. Identifying predictors of non-response is crucial for optimizing treatment strategies and improving patient outcomes. Recent evidence has shown a lower biochemical response among patients of Hispanic ethnicity, which is often underrepresented in clinical research. The findings have significant implications for clinical practice, and are of particular interest in countries that have limited access to liver transplantation. Patients / Materials and Methods: This is a single center, retrospective, propensity score-matched cohort study, which included all patients with PBC confirmed by liver biopsy that were followed by the hepatology clinic from January 1st, 2015 to March 1st 2024 under treatment with UDCA. A biochemical response was defined according to the Toronto criteria, with an alkaline phosphatase (ALP) <1.67 x ULN after 2 years of UDCA therapy. Patients were subdivided on the presence or absence of a biochemical response. The primary outcome was mortality due to a liver related event (LRE), the secondary outcomes were variables associated with non-response. Results and Discussion: A total of 132 patients were included, 70 were non responders and 62 fulfilled Toronto criteria of response. The predominant gender was female in both groups (96.78% and 96%) with a median of 56 years of age for the non-responders and 58 years for those who did. Mortality due to LRE in the no response vs responders group was 41% vs 6.2%, respectively, a difference which was statistically significant (OR 3.67, 95% CI [1.608, 8.411], p<0.001). Factors associated with incomplete response were statistically significant for a baseline level of ALP > 2 x ULN (OR 5.3, 95% CI [2.433, 11.649], p<0.001), a baseline level of ALT > ULN (OR 5.3, 95% CI [2.429, 11.845], p<0.001) and a baseline level of AST > ULN (OR 7.8, 95% CI [3.554, 17.159] p<0.001). All of these variables remained ss after multivariate regression analysis. Conclusions: Among patients with PBC that receive initial therapy with UDCA, a baseline increased ALP, AST and ALT are associated with an incomplete biochemical response, identifying patients that might benefit from early initiation of additional therapies. Prospective studies are needed.
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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 | 0.000 | 0.002 |
| 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".