Introduction

Currently, there are several prognostic scores developed to predict mortality in liver cirrhosis. Child-Pugh-Turcotte (CPT) and MELD-Na scores are the most used and validated in current practice. Recently, BAVENO consensus issued new recommendations for a better assessment of the rate of decompensation of liver cirrhosis as well as long- and short-term mortality rates. In this study, we aimed to evaluate the accuracy of both CPT and MELD-Na scores to predict BAVENO stages.

Aims & Methods

We conducted a retrospective study in which consecutive patients with liver cirrhosis admitted to the St. Spiridon Emergency Hospital Iasi between January 2023 and April 2024, were included. All cases were assigned to different prognostic stages according to BAVENO and MELD-Na and CPT scores were compared between the groups.

Results

Of the 155 patients included, 54.8% were males, with an average age of 57.81±12.36 years. According to BAVENO staging, 68% of patients were classified as a BAVENO stage 6, 10% as stage 5, 5% as stage 4, 10% as stage 3, 6% as stage 2, and 1% as stage 1. We found a positive correlation between MELD-Na Score and Child Pugh Score (r=0,774) with significant p-value (P<0.0001). Furthermore, our results demonstrate superior sensitivity and specificity for the MELD-Na score (98.7% and 97.9%, AUC-0.997) compared to the Child-Pugh score, which showed a sensitivity of 71.2% (AUC-0.792) to predict a stage 6 diagnosis and worst prognosis overall. At a cut-off of 34, MELD-Na score was the most accurate to discriminate between BAVENO stage 5 and 6, a cut off of 22 between BAVENO 4 and 5 and a cut off of 13 was the most accurate to discriminate between BAVENO stage 3 and stage 4.

Conclusion

Mortality rates and poor prognosis increase exponentially with liver cirrhosis decompensation, thus their assessment through predictive scores remains a highly desirable target for clinicians, MELD-Na score retaining its superiority in predicting the evolution through the BAVENO stages.

Introduction

Patients with inflammatory bowel disease (IBD) experiencing severe flares are at increased risk of opportunistic infections, particularly cytomegalovirus (CMV), due to immunosuppressive therapy.

Aims & Methods

This study aimed to assess the prevalence and risk factors associated with CMV infection during severe acute colitis.
We conducted a retrospective analytical study on hospitalized patients with severe acute colitis. CMV infection was confirmed by positive anti-CMV IgM serology, positive colonic biopsy PCR for CMV DNA, or histological evidence of CMV cytopathic effect. Patients were divided into two groups: Group 1 (CMV-positive) and Group 2 (CMV-negative). Clinical, biological, and therapeutic data were compared (SPSS, p<0.05).

Results

Among 41 patients (mean age 39.8 years, 14 men), 17 (41.5%) had confirmed CMV infection. CMV was diagnosed by PCR (n=13), serology (n=3), or histology (n=1). Most received antiviral therapy (Ganciclovir or Valganciclovir). One patient required emergency colectomy; three experienced relapse, with two receiving Foscarnet and one undergoing colectomy for bleeding. No significant association was found between CMV infection and age, sex, disease duration, corticosteroid or immunosuppressant use, anemia, hypoalbuminemia, or CRP >45 mg/L. However, CMV infection was significantly associated with steroid resistance (p=0.003).

Conclusion

CMV infection is frequent during severe IBD flares and is strongly associated with corticosteroid resistance. Early recognition of this risk factor is essential for timely diagnosis and management to avoid complications.

Introduction

Patients with ulcerative colitis (UC) and concurrent cytomegalovirus (CMV) colitis are at higher risk of poorer outcomes, including developing steroid refractoriness or toxic megacolon. Given its relevance, the European Crohn's and Colitis Organization recommends, in case of flare-ups, to search for CMV by endoscopic biopsy, preferably with tissue polymerase chain reaction (PCR) or alternatively with immunohistochemistry (IHC).

Aims & Methods

The aims of our study were to compare the diagnostic yield of tissue and plasma CMVDNA PCR to IHC and to explore the different level of tissue viral load in both steroid-refractory and steroid-sensitive UC patients. This prospective study included consecutive patients undergoing colonoscopy or proctosigmoidoscopy for UC, independent of disease activity, in a single tertiary center betwen July 2024 and January 2025. Patients underwent the same day endoscopy with multiple biopsies (3 from sigmoid colon and 4 from rectum) and plasma sampling for CMVDNA analysis using real-time quantitative PCR assay; histological presence of CMV was evaluated using IHC and hematoxylin-eosin staining. Concordance among CMV detection techniques was calculated using K cohen concordance index. Continuous variables were compared using Mann-Whithney test. ROC analysis allowed to identify an ideal cut-off of viral load value of CMV infection.

Results

Twenty-one consecutive patients were enrolled. Twelve (57,1%) patients were male and 9 (42,9%) female, (range 19-79 years). Nine (42,8%) patients had a diagnosis of pancolitis, three (14,3%) of left-sided UC, seven (33,4%) of procto-sigmoiditis and two (9,5%) of proctitis. Six (28,6%) patients were subclassified as steroid-refractory, the remaining fifteen (71,4%) as steroid-responsive.
IHC positivity was observed in tissue samples from 3 (14,3%) patients, while CMVDNA was detected in tissue samples from 5 (23,8%) patients and in 3 (14,3%) plasma samples. Comparing IHC to plasma CMVDNA, the k index was only fair consistent (0.277 CI -0.327 to 0.758), while IHC versus tissue DNA showed a higher consistency, with a k index of 0.500 (CI 0.048 to 0.952).
Interestingly, the mean value of tissue CMVDNA in the steroid-refractory group was higher, although not significant, than the steroid-responsive group (respectively 140.00 copies/mg ±260.00 vs 98.00 copies/mg ±360.00, p value= 0.14). In order to identify a possible tissue CMVDNA level able to distinguish between the two groups, a receiver operating characteristic (ROC) curve analysis was performed: a cut-off value of 102.56 was associated with a sensitivity of 92.86% and a specificity of 33.3%, resulting in a likelihood ratio of 1.39. The area under the ROC curve (AUC) was 0.6667 ± 0.1415, indicating a modest discriminative ability.

Conclusion

This study showed a good concordance between immunohistochemistry and tissue PCR for the detection of CMV in UC patients. Steroid-refractory UC patients showed a higher tissue viral load compared to steroid-responsive patients.

Disclosure

No conflict of interest to declare

Introduction

Helicobacter pylori (Hp) infection is highly prevalent in Portugal, affecting over 60% of the population. Antibiotic resistance poses a significant challenge to Hp treatment; however, empirical regimens remain the standard of care over susceptibility-guided approaches. This study aims to evaluate the most recommended therapeutic options for Hp eradication and to identify risk factors associated with treatment failure.

Aims & Methods

Prospective cohort study conducted in a single centre, including all patients treated for Hp infection between 2013 and 2024. We analysed four eradication regimens: triple therapy (Tri), bismuth quadruple therapy (QuadB), concomitant quadruple therapy (QuadC) and sequential quadruple therapy (QuadS). We collected data on patient demographics and clinical characteristics and compared adherence rates, treatment effectiveness and incidence of adverse events.

Results

Included 591 patients, with a median age of 57 years (IQR 47-66) and female sex 57.2%. The main indication for Hp testing was dyspeptic symptoms (61.1%). The prescribed therapeutic regimens were QuadC in 34.0% of patients, QuadB in 32.8%, Tri in 23.2% and QuadS in 10.0%. According to the intention-to-treat analysis, QuadC (92.9%) and QuadB (90.4%) showed significantly higher eradication rates compared with Tri (73.9%, p<0.001), with no difference observed for QuadS (84.2%, p=0.30 vs QuadC; p=0.61 vs QuadB). Adverse events were significantly less frequent with Tri (0.06%) and QuadS (0.02%) compared to QuadC (0.18%, p<0.01) and QuadB (0.17%, p<0.05), but overall adherence to treatment was 97.1%, with no significant difference among regimens (p=0.19). Logistic regression identified predictive factors for treatment failure: prior eradication attempts (OR 2.31; 95% CI 0.3-1.4), poor adherence (OR 14.5; 95% CI 0.7-4.7) and absence of statin use (OR 2.33; 95% CI 0.07-1.6), with an AUC of 0.72.

Conclusion

QuadC and QuadB therapies are more effective for Hp eradication but are associated with increased rates of adverse events, without a negative impact on overall treatment adherence. Therapeutic failure is more likely in non-naive patients, those with poor adherence to treatment and without statin use.