A new study by University of North Carolina researchers has found dramatic improvements in the survival of patients with cirrhosis and liver failure supporting improved treatment strategies for patients with cirrhosis and concurrent bacterial infections.
The study analysed more than 780,000 hospitalisations of patients with cirrhosis from 2002 to 2010 and found that inpatient mortality decreased steadily during that period despite increases in patient age and the necessity for more complex medical care. The study used the Health Care Cost and Utilisation Project National Inpatient Sample, the largest sampling of US hospitals to date.
Monica Schmidt, research associate at the UNC Liver Centre and doctoral candidate at the Gillings School of Global Public Health, and lead author of the study said: "While the number of cirrhosis hospitalisations increased during the sample period, the rate of hospital deaths fell by 41%," Schmidt said. "In addition, the decline in mortality for cirrhosis patients dropped significantly compared to non-cirrhotic patients. Increased awareness of disease management and earlier diagnosis for cirrhosis-related complications may have led to better survival rates."
Co-authoring and overseeing the study were Dr A Sidney Barritt, assistant professor of medicine, Dr Eric Orman, assistant professor of medicine and Dr Paul H Hayashi, associate professor of medicine in UNC's division of gastroenterology and hepatology.
"These data are encouraging because there has been a lot of research effort put into improving inpatient cirrhosis care over the years, and it appears it may be paying off," Hayashi said.
Liver disease, or cirrhosis, is the eighth-leading cause of death in the US and often requires hospitalisation for complications that can include bleeding, confusion, cancer and susceptibility to bacterial infections.
Cirrhosis-related admissions to hospitals continue to grow. Care of cirrhosis patients is complex and often managed by a team of gastroenterologists, hepatologists, intensivists and nephrologists. The study targeted all causes and forms of liver cirrhosis.
While the decline in patient deaths was good news, the study found that cirrhosis patients do much worse than other patients with sepsis (bacterial infections). The mortality risk for infections actually increased over time, despite the ongoing "surviving sepsis campaign." The increased risk for cirrhosis patients may be related to abnormal blood-flow issues and immune responses that could hinder survival.
The study suggests that improving cirrhosis care may be leading to better overall survival, but notes that rising mortality risks for sepsis suggest a more tailored approach is needed for treating sepsis in patients with cirrhosis. The study’s authors suggest that these data can help in setting appropriate quality care indicators and setting guideline use as well as determining adjusted mortality risk and use of palliative care.
[link url="http://news.unchealthcare.org/news/2015/april/cirrhosis-deaths-drop-41-percent-from-2002-to-2012"]University of North Caroline Healthcare material[/link]
[link url="http://www.gastrojournal.org/article/S0016-5085%2815%2900117-1/abstract"]Gastroenterology abstract[/link]