Development and External Validation of an Endoscopic and Histologic Pouchitis Assessment Tool: The Atlantic Pouchitis Index
Bibliographic record
Abstract
BACKGROUND & AIMS: No fully validated indices to measure pouchitis activity exist. We aimed to develop and externally validate a novel endoscopic and histologic index. METHODS: Endoscopists and pathologists used 11 (4 endoscopic, 4 histologic, 3 composite) existing indices and items from a prior Research and Development/University of California Los Angeles appropriateness exercise to assess pouchitis disease activity in videos and images from 98 patients with chronic antibiotic-refractory pouchitis who participated in a randomized placebo-controlled alicaforsen trial. Reliability was assessed with the intraclass correlation coefficient (ICC). Responsiveness was quantified by the area under the receiver operating characteristic curve (AUROC). A novel index was developed using linear regression with a visual analog scale (VAS) of pouchitis endoscopic and histologic disease activity as the dependent variable and was externally validated with the EARNEST vedolizumab trial data. RESULTS: The Atlantic Pouchitis Index (API) (range, 0-69) comprises the Simple Endoscopic Score for Crohn's Disease and Robarts Histopathology Index. The API exhibited almost perfect intra-rater (ICC, 0.88; 95% confidence interval [CI], 0.81-0.92) and substantial inter-rater reliability (ICC, 0.72; 95% CI, 0.60-0.79). A high degree of responsiveness (AUROC, 0.95; 95% CI, 0.89-0.98), greater than existing endoscopic indices (ΔAUROC, 0.09-0.24; P ≤ .005), was observed when the change criterion was a decrease in the VAS of one-half of the standard deviation. Good responsiveness was observed in external validation when vedolizumab was the change criterion (AUROC, 0.63; 95% CI, 0.51-0.73). CONCLUSIONS: Development and validation of the API advances pouchitis disease assessment. Integration of endoscopy and histopathology results in an objective, reliable, and responsive instrument to evaluate therapy effectiveness in research and clinical settings.
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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 | 0.054 | 0.090 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".