Full adherence to cirrhosis quality indicators is associated with lower mortality in acute variceal bleeding: Nationwide audit.

Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 8302946 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3350 (Electronic) Linking ISSN: 02709139 NLM ISO Abbreviation: Hepatology Subsets: MEDLINE

Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc.
Original Publication: Baltimore, MD : Williams & Wilkins, [c1981]-

Gastrointestinal Hemorrhage*/mortality ; Liver Cirrhosis*/mortality ; Liver Cirrhosis*/complications ; Esophageal and Gastric Varices*/mortality ; Quality Indicators, Health Care*; Humans ; Male ; Female ; Middle Aged ; Singapore/epidemiology ; Aged ; Guideline Adherence/statistics & numerical data ; Adrenergic beta-Antagonists/therapeutic use ; Hemostasis, Endoscopic ; Vasoconstrictor Agents/therapeutic use ; Antibiotic Prophylaxis/standards ; Antibiotic Prophylaxis/statistics & numerical data ; Medical Audit ; Cohort Studies ; Acute Disease ; Propensity Score

Background and Aims: Acute variceal bleeding (AVB) is a major complication in patients with cirrhosis. Using a nationwide AVB audit, we performed a nested cohort study to determine whether full adherence to the AVB quality indicator (QI) improves clinical outcomes in patients with cirrhosis and AVB.
Approach and Results: We assessed real-world adherence to AVB QI among patients with cirrhosis admitted for AVB in all public hospitals in Singapore between January 2015 and December 2020. Full adherence was considered when all 5 QIs were fulfilled: prophylactic antibiotics, vasoactive agents, timely endoscopy, endoscopic hemostasis during index endoscopy, and nonselective beta-blockers after AVB. We compare 6-week mortality between the full adherence and suboptimal adherence groups using a propensity-matched cohort.A total of 989 patients with AVB were included. Full adherence to all AVB QI was suboptimal (56.5%). Analysis of the propensity-matched cohort with comparable baseline characteristics showed that full adherence was associated with a lower risk of early infection (20.0% vs. 26.9%), early rebleeding (5.2% vs. 10.2%), and mortality at 6 weeks (8.2% vs. 19.7%) and 1 year (21.3% vs. 35.4%) ( p <0.05 for all). While full adherence was associated with a lower 6-week mortality regardless of the MELD score, nonadherence was associated with a higher 6-week mortality despite a lower predicted risk of 6-week mortality. Despite high adherence to the recommended process measures, patients with CTP-C remain at a higher risk of rebleeding, 6-week and 1-year mortality.
Conclusions: Full adherence to the AVB QI should be the target for quality improvement in patients with cirrhosis.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Comment on: Hepatology. 2019 Apr;69(4):1787-1797. doi: 10.1002/hep.30489. (PMID: 30586188)

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0 (Adrenergic beta-Antagonists)
0 (Vasoconstrictor Agents)

Date Created: 20240221 Date Completed: 20240918 Latest Revision: 20241007

20241008

PMC11407775

10.1097/HEP.0000000000000793

38381716