The BSG/BASL bundle for patients admitted with decompensated chronic liver disease improves standard of care but utilisation is poor across the UK

Results

There were 1,179 admissions from 1,124 patients from 99 sites across the UK included, making this the largest audit of the BSG/BASL admission care bundle to date. Median age was 58.00 years (interquartile range (IQR) 48.00–68.00), 62.00% were men, 59.28% were admitted out of hours, 87.62% had an underlying diagnosis of ARLD or non-alcoholic fatty liver disease (NAFLD) and median model for end-stage liver disease (MELD) score was 16.50 (IQR 12.00–21.00). Patient admission mortality was 15.80%.

Uptake of the bundle was low at 9.41%. There was significant geographical variation in use between NHS regions, with NHS North East and Yorkshire being the highest users (26.92% of admissions). When comparing admissions where the bundle was used to those where it was not, it was significantly more likely to be used in admissions for patients with ARLD (90.09% vs 72.57%; p<0.0001), with jaundice as presenting complaint (25.23% vs 13.95%; p=0.003) and with higher MELD scores (19.00 (IQR 14.00–22.00) vs 16.00 (IQR 12.00–21.00); p=0.008). Bundle use was associated with improved standards of care within the first 24 hours of admission. Compared with admissions where the bundle was not used, there was significantly increased completion of necessary blood tests, septic screens, ascitic taps, alcohol history and care plan completion, and acute kidney injury care plan completion. Patients with a completed bundle were more likely to see a gastroenterologist/hepatologist within 24 hours. Mortality was higher in patients where the bundle was used. However, when adjusted for age and MELD scores, this was not significant (adjusted odds ratio 1.62 (95% confidence interval 0.93–1.75)).