Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612725
Poster Visit Session II Clinical Hepatology – Friday, January 26, 2018, 2:35pm – 3:20pm, Room 120
Georg Thieme Verlag KG Stuttgart · New York

How well are we managing decompensated liver cirrhosis?

M Goonoo
1   Sheffield Teaching Hospitals NHS Trust, Gastroenterology, Sheffield
,
H Beresford
1   Sheffield Teaching Hospitals NHS Trust, Gastroenterology, Sheffield
,
D Gleeson
1   Sheffield Teaching Hospitals NHS Trust, Gastroenterology, Sheffield
,
C Salmon
1   Sheffield Teaching Hospitals NHS Trust, Gastroenterology, Sheffield
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2018 (online)

 

Background:

Thirty-day mortality rate in decompensated liver cirrhosis (DLC) is 10 – 20%. The 2013 National Confidential Enquiry into Patient Outcome and Death highlighted gaps in management of inpatients with DLC, leading to the British Society of Gastroenterology (BSG) producing a “Decompensated Cirrhosis Care Bundle” (DCCB) to help initial management of these patients.

Aims:

To assess whether management of inpatients with DLD, over the first 24 hours, is consistent with BSG recommendations.

Methods:

We collected data prospectively on 22 inpatients (17 men, median age 58 yr) with DLC seen over 4 weeks

in April/May 2017. We compared their management to the standards in the DCCB, regarding: (1) timely specialist review (2) initial investigations, and management of (3) alcohol withdrawal, (4) sepsis, (5) acute kidney injury (AKI) (6) gastrointestinal bleeding (7) encephalopathy; and (8) thromboprophylaxis.

Results:

All 22 patients had specialist review within 24 hours. Serum calcium, phosphate and magnesium levels were checked only in 6, 5 and 6 patients respectively. Blood cultures were taken in only 4, urine analysed in 6 and chest X- ray performed in 13. Only 7 of the 16 patients with ascites had diagnostic paracentesis; all results were acted on appropriately. Alcohol history was undocumented in 5 patients. Of 8 patients with suspected hepatic encephalopathy, four underwent CT head scan (one had subdural haematoma). Medical management of suspected infection, AKI and GI bleeding was deemed adequate. Of 19 patients eligible for chemical thrombo-prophylaxis, 3 received none.

Conclusions:

Our management of patients with DLC is not fully compliant with BSG recommendations, potentially impacting on their outcome. We plan to implement a checklist, based on the BSG DCCB, and to review its impact on care quality