Background: Hepatic encephalopathy (HE) is an adverse prognostic indicator of liver cirrhosis, often triggered by various precipitating factors, with gastrointestinal bleeding being the most common. Comparing the Child–Pugh and Model for End-Stage Liver Disease (MELD) scores to predict the severity and outcome of complications in patients with cirrhosis could help establish an accurate prognosis. Methods: We retrospectively reviewed the records of patients with cirrhosis aged 18 and older who were referred to the Gastroenterology Department at Imam Khomeini Hospital in Ahvaz from April to September 2023. A statistical analysis was conducted to compare MELD and Child-Pugh score (CPS) in 95 patients with cirrhosis. Results: The in-hospital mortality rate was strongly correlated with certain complications of cirrhosis. Gastrointestinal bleeding and HE showed statistical significance (P < 0.05). Additionally, the co-occurrence of cirrhosis complications, particularly HE in conjunction with others, was associated with increased mortality rates. Abnormal levels of the international normalized ratio, prothrombin time, partial thromboplastin time, bilirubin, and liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) were also associated with mortality (P < 0.05). Specific laboratory factors in ascites fluid, namely total cell count and red blood count, were linked to the 6-month survival rate (P < 0.05). Furthermore, CPS was identified as a more specific and sensitive independent predictor of 6-month in-hospital survival than the MELD score (logistic regression: odds ratio, 2.3; standard error, 0.0189; P < 0.05). Conclusion We recommend continuing to use the CPS for predicting in-hospital mortality in patients with cirrhosis and for the individual evaluation of liver disease in daily clinical practice.

Background: Hepatic encephalopathy (HE) is an adverse prognostic indicator of liver cirrhosis, often triggered by various precipitating factors, with gastrointestinal bleeding being the most common. Comparing the Child–Pugh and Model for End-Stage Liver Disease (MELD) scores to predict the severity and outcome of complications in patients with cirrhosis could help establish an accurate prognosis. Methods: We retrospectively reviewed the records of patients with cirrhosis aged 18 and older who were referred to the Gastroenterology Department at Imam Khomeini Hospital in Ahvaz from April to September 2023. A statistical analysis was conducted to compare MELD and Child-Pugh score (CPS) in 95 patients with cirrhosis. Results: The in-hospital mortality rate was strongly correlated with certain complications of cirrhosis. Gastrointestinal bleeding and HE showed statistical significance (P < 0.05). Additionally, the co-occurrence of cirrhosis complications, particularly HE in conjunction with others, was associated with increased mortality rates. Abnormal levels of the international normalized ratio, prothrombin time, partial thromboplastin time, bilirubin, and liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) were also associated with mortality (P < 0.05). Specific laboratory factors in ascites fluid, namely total cell count and red blood count, were linked to the 6-month survival rate (P < 0.05). Furthermore, CPS was identified as a more specific and sensitive independent predictor of 6-month in-hospital survival than the MELD score (logistic regression: odds ratio, 2.3; standard error, 0.0189; P < 0.05). Conclusion We recommend continuing to use the CPS for predicting in-hospital mortality in patients with cirrhosis and for the individual evaluation of liver disease in daily clinical practice.

Background: Hepatic encephalopathy (HE) is an adverse prognostic indicator of liver cirrhosis, often triggered by various precipitating factors, with gastrointestinal bleeding being the most common. Comparing the Child–Pugh and Model for End-Stage Liver Disease (MELD) scores to predict the severity and outcome of complications in patients with cirrhosis could help establish an accurate prognosis. Methods: We retrospectively reviewed the records of patients with cirrhosis aged 18 and older who were referred to the Gastroenterology Department at Imam Khomeini Hospital in Ahvaz from April to September 2023. A statistical analysis was conducted to compare MELD and Child-Pugh score (CPS) in 95 patients with cirrhosis. Results: The in-hospital mortality rate was strongly correlated with certain complications of cirrhosis. Gastrointestinal bleeding and HE showed statistical significance (P < 0.05). Additionally, the co-occurrence of cirrhosis complications, particularly HE in conjunction with others, was associated with increased mortality rates. Abnormal levels of the international normalized ratio, prothrombin time, partial thromboplastin time, bilirubin, and liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) were also associated with mortality (P < 0.05). Specific laboratory factors in ascites fluid, namely total cell count and red blood count, were linked to the 6-month survival rate (P < 0.05). Furthermore, CPS was identified as a more specific and sensitive independent predictor of 6-month in-hospital survival than the MELD score (logistic regression: odds ratio, 2.3; standard error, 0.0189; P < 0.05). Conclusion We recommend continuing to use the CPS for predicting in-hospital mortality in patients with cirrhosis and for the individual evaluation of liver disease in daily clinical practice.

Purpose: This study aimed to investigate the efficacy of hydrocortisone enema in preventing radiation proctitis in patients with rectal cancer undergoing short-course radiotherapy (SCRT). Methods: This phase II randomized controlled trial enrolled patients with newly diagnosed locally advanced rectal cancer (clinically staged T3–4 and/or N1–2M0). Participants received a median of 4 cycles of neoadjuvant chemotherapy (capecitabine plus oxaliplatin) followed by 3-dimensional conformal SCRT (25 Gy in 5 fractions). Patients were randomly assigned to receive either a hydrocortisone enema (n=50) or a placebo (n=51) once daily for 5 consecutive days during SCRT. The primary endpoint was the incidence and severity of acute proctitis. Results: Of the 111 eligible patients, 101 were included in the study. Baseline characteristics, including sex, age, performance status, and tumor location, were comparable across the treatment arms. None of the patients experienced grade 4 acute gastrointestinal toxicity or had to discontinue treatment due to treatment-related adverse effects. Patients in the hydrocortisone arm experienced significantly less severe proctitis (P<0.001), diarrhea (P=0.023), and rectal pain (P<0.001) than those in the placebo arm. Additionally, the duration of acute gastrointestinal toxicity following SCRT was significantly shorter in patients receiving hydrocortisone (P<0.001). Conclusion Hydrocortisone enema was associated with a significant reduction in the severity of proctitis, diarrhea, and rectal pain compared to placebo. Additionally, patients treated with hydrocortisone experienced shorter durations of gastrointestinal toxicity following SCRT. This study highlights the potential benefits of hydrocortisone enema in managing radiation-induced toxicity in rectal cancer patients undergoing radiotherapy.