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Record W4413305591 · doi:10.1136/bcr-2025-265370

Discordance between biochemical and histological severity in persistent immune checkpoint inhibitor induced liver injury

2025· article· en· W4413305591 on OpenAlexaff
Chloe Attree, Samuel D. Saibil, Sandra E. Fischer, Morven Cunningham

Bibliographic record

VenueBMJ Case Reports · 2025
Typearticle
Languageen
FieldMedicine
TopicCancer Immunotherapy and Biomarkers
Canadian institutionsUniversity of TorontoPrincess Margaret Cancer CentreToronto General Hospital
Fundersnot available
KeywordsImmunosuppressionMedicineLiver injuryNivolumabIpilimumabLiver biopsyPrednisoneElevated liver enzymesHistopathologyBiopsyHepatitisInternal medicineImmune systemGastroenterologyPathologyImmunologyImmunotherapyBiology

Abstract

fetched live from OpenAlex

We report a case of a man in his early 70s referred for Grade 2 immune checkpoint inhibitor induced liver injury (ChILI) post nivolumab and ipilimumab for metastatic melanoma. Despite treatment with immunosuppression, the liver enzymes improved but failed to normalise completely. Liver biopsy performed 6 months after diagnosis identified a severe hepatitis with interface and perivenular necroinflammatory activity. Mycophenolate was up-titrated to 1 g twice daily and prednisone 40 mg daily was commenced. Once liver enzymes normalised immunosuppression was then gradually withdrawn, with no recurrent elevation of the liver enzymes. This case demonstrates that there can be an incongruency between liver enzymes an histopathology in ChILI. As in our patient, this can have significant implications in managemen. Furthermore, this case is unique as there are no other reported cases in the literature of chronic ChILI.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: none
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.494
Threshold uncertainty score0.557

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.029
GPT teacher head0.314
Teacher spread0.285 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designObservational
Domainnot available
GenreEmpirical

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".

Quick stats

Citations1
Published2025
Admission routes1
Has abstractyes

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