Introduction
Incidence of liver cirrhosis is rising worldwide. Decompensated liver cirrhosis (DLC) is associated with 10–20% inpatient mortality.
Recognition of conditions and starting an early effective intervention can save lives and reduce hospital stay in patients with DLC. A recent National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report in 2013 revealed that only 47% of patients received good care.
Due to that report, British Society of Gastroenterology–British Association for the Study of the Liver (BSG–BASL) has developed the ‘Cirrhosis care bundle pathway’ which provides a checklist to ensure that all appropriate investigations are undertaken when a patient with DLC presents to the hospital. These investigations should be performed ideally within 6 to 24 hours of attendance.
Method
The aim of the study was to audit the current practice in our trust against the ‘BSG–BASL cirrhosis care bundle pathway’ proforma.
Gastroenterology junior doctors visited the medical admission units daily to identify patients admitted with DLC over a 6 week period.
Results
The majority of the patients (74%) were male. All were Caucasians.
The median age was 50 years (range: 27, 83 years).
The median number of days in hospital was 14.5 days (range: 3, 86 days).
Six patients died (17% mortality rate).
Eighty per cent of patients (n=28) were seen by a gastroenterologist within 24 hours of admission.
Conclusions
This audit highlighted the need for improvement in many areas:
Basic investigations such as liver function tests, coagulations, electrolytes (Ca/Mg/PO4) should be checked in all patients with DLC.
Alcohol intake should be documented in all patients (only 77% were noted in our study).
All patients presented with ascites should have ascitic tap (only 44% in this study).
Don't forget to give albumin in spontaneous bacterial peritonitis (only 20% received albumin).
Think of low-molecular-weight heparin in DLC patients with no evidence of gastrointestinal bleed since they are at risk of developing thromboembolism.
Conflict of interest statement
None declared.
- © Royal College of Physicians 2019. All rights reserved.
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