How well do we manage sick livers?
Connolly E, O'Morain N, Gilcreest M, O'Connor A
Department of Gastroenterology AMNCH Tallaght Hospital
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
To assess the management of decompensated cirrhosis.
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
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).
Decompensated cirrhosis is poorly recognised an poorly managed within 24 hours of admission. Greater awareness of the care bundle should improve outcomes.