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Cirrhosis outcomes: 6 reports on quality of life, readmission, palliative care

Recent research into liver cirrhosis has focused on identifying factors that may prevent progression from earlier stages of fibrosis along with improving care for patients once diagnosed, as there is no curative therapy.

The following reports include data on how hospital length of stay was linked to cirrhosis-related readmission, the affect of malnutrition on patient quality of life in cirrhosis cases, and improving patient understanding of palliative care options.

Cirrhosis often follows alcohol-related health care visits

The incidence of alcohol-related liver cirrhosis among patients identified as high-risk ranged from 7% to 16% after approximately a decade of heavy drinking, and many patients had health care contact for alcohol misuse prior to diagnosis, according to results from a recently published study.

“Preventive interventions targeting such high-risk individuals include the delivery of brief interventions or cognitive-behavioral therapies shown to be associated with decreased mortality,” Gro Askgaard, MD, PhD, from the Copenhagen University Hospital in Denmark, and colleagues wrote. “Should interventions be effective in the prevention of alcoholic liver cirrhosis in high-risk populations, there should be opportunities to reach the majority of patients prior to their diagnosis. Alcohol-related health care contacts before alcoholic liver cirrhosis diagnosis represent such an opportunity.” Read more

Short hospital length of stay linked to cirrhosis-related readmission

The 30-day readmission rate among patients with cirrhosis was 55% in a recent study and was tied to short hospital length of stay, as presented at the American College of Gastroenterology Annual Meeting.

“Decompensated cirrhosis is one of the most common causes of hospital readmissions in the United States,” Chandraprakash Umapathy, MD, MS, from the University of California in San Francisco, said during his presentation. “One in every four patients with more than three complications of cirrhosis readmitted within 30 days and one-third readmitted within 90 days. We sought to determine the national readmission rates in cirrhosis and the causes and predictors of readmission.” Read more

Malnutrition decreases quality of life, social function in cirrhosis

Malnutrition as measured by subjective global assessment correlated significantly with decreased health-related quality of life in patients with cirrhosis, according to research presented at the American College of Gastroenterology Annual Meeting.

“I was quite surprised by how limited the literature was in regards to malnutrition and quality of life in cirrhosis, given that the prevalence of malnutrition in cirrhosis is so high and the complications of malnutrition are quite profound, including infections, portal hypertension and increased hospitalizations and mortality,” Elaine Chiu, MD, RD, from the University of Calgary in Alberta, Canada, said during her presentation. Read more

Composite score predicts hepatic encephalopathy admission

The MoCA-CFS composite score — developed using the Montreal Cognitive Assessment and the Clinical Frailty Scale — independently predicted hospital admissions for hepatic encephalopathy and impaired health-related quality of life among patients with cirrhosis, according to recently published data.

“There is a clinical need to identify more practical screens that can assist us to determine which patients are at high risk of short-term [hepatic encephalopathy (HE)]-related hospital admissions,” Michael Ney, MD, from the University of Alberta in Canada, and colleagues wrote. “Once identified, management of these high-risk patients can be intensified in an attempt to reduce admission rates and the associated healthcare costs.” Read more

Alcohol use disorder therapy could improve chronic liver disease outcomes

Details from a recently published review discussed expanded use of alcohol use disorder medications and treatments in everyday clinical practice for patients with advanced liver disease.

“Alcohol use is a major cause of preventable liver disease worldwide, and alcoholic liver disease is the main alcohol-related chronic medical illness,” Daniel Fuster, MD, PhD, from the Autonomous University of Barcelona in Spain, and Jeffrey H. Samet, MD, MPH, from the Boston University School of Medicine and Public Health in Boston and chief of General internal medicine at Boston Medical Center, wrote in their review. “Globally, per capita alcohol consumption is strongly correlated with the rate of death due to liver cirrhosis.” Read more

Patients report poor understanding of liver disease, palliative care options

Results of an international systematic review showed that patients and their families had a poor understanding about advanced liver disease, felt they needed more information about treatments and how to get practical and psychological support, and were unaware of the potential for palliative care.

Additionally, the review showed that general practitioners and hepatology specialists often found it difficult to discuss the seriousness of advanced liver disease and the options for future care with their patients. Read more