TBA (17W106)

How well do we manage sick livers?

Author(s)

Connolly E, O'Morain N, Gilcreest M, O'Connor A

Department(s)/Institutions

Department of Gastroenterology AMNCH Tallaght Hospital

Introduction

Decompensated cirrhosis is increasingly prevalent and has high mortality. Its management is complex. Delays in initiating treatment can be fatal. A ‘Cirrhosis Care Bundle’ was introduced by the British Society of Gastroenterology (BSG) to improve early identification and management of decompensated livers within 24 hours of admission

Aims/Background

To assess the management of decompensated cirrhosis.

Method

This audit reviewed all admissions due to decompensated cirrhosis during a 4 month period. Chart reviews were performed 3-5 days post admission to retrospectively assess management. Key elements of the care bundle were selected as surrogate markers for overall management; biochemical parameters, alcohol withdrawal awareness, diagnostic paracentesis, Vitamin K therapy and early referral to Endoscopy

Results

There were 29 admissions identified between March – June 2017 due to decompensated cirrhosis (female n=18, 62%, Age range 42-84). Alcohol (n=19, 65%) was the main aetiology. All (n=29, 100%) had FBC, renal, liver profile within 24 hours of admission. Coagulation studies were not performed in 4 (14%). Alcohol intake was recorded in units in 47% (9/19), with IV Pabrinex and withdrawal scale prescribed for 58% (11/19). With elevated Prothrombin time (n=24), Vitamin K was prescribed in 42% (n=10). For suspected ascites (n=22), diagnostic tap was attempted in 18% (n=4) within 24 hours. Variceal bleed was suspected in 34% (n=10), for whom Terlipressin was prescribed in 30% (n=3), and early referral for Endoscopy was requested in 80% (n=8).

Conclusions

Decompensated cirrhosis is poorly recognised an poorly managed within 24 hours of admission. Greater awareness of the care bundle should improve outcomes.