The Management Of Patients With Decompensated Liver Cirrhosis In The First 24 Hours- Room To Improve?
Department of Gastroenterology and Hepatology, St James's Hospital,Dublin
Decompensated liver cirrhosis is associated with significant mortality. The correct and timely management of patients reduces morbidity.The British Association for the Study of the Liver (BASLD)-Decompensated Cirrhosis Care Bundle has demonstrated improvements in the management of patients with decompensated cirrhosis.
To assess the initial management of patients with decompensated liver cirrhosis presenting to the Emergency Department.
We carried out an audit using the BASLD-Decompensated Cirrhosis Care Bundle-First 24Hours as an audit tool over a 3 month period.
24 patients with decompensated liver cirrhosis were included, 84%(n=20) due to alcohol-related liver cirrhosis. 71% (n=17) presented with ascites, 25%(n=6) encephalopathy and 4%(n=1) had a variceal bleed. 29%(n=7) had an AKI and/or hyponatremia. A diagnostic tap was performed in 59% (n=10) of patients with ascites. On admission, 41%(n=7) of patients were weighed, 50%(n=12) had urine cultures and 21%(n=5) blood cultures taken. Lactulose was started in 83%(n=5) of patients with encephalopathy. 71%(n=5) had diuretics and other nephrotoxins stopped and urine output monitored. A liver ultrasound was booked 83%(n=20) of patients and a hepatology consult was sought in 87.5%(n=21) of cases. Antibiotics and terlipressin were started in the patient with a variceal bleed.
This audit demonstrates the initial care of patients with decompensated liver cirrhosis is suboptimal. As a result of this audit, we have introduced an electronic decompensated care bundle in our hospital to remind admitting and primary teams of the stepwise approach to the care of these patients. We plan to re-audit the care received following introduction of this bundle after 6 months.