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PWE-4 Clinic non-attendance in alcohol-related liver disease is very common, and linked to poorer 1-year outcomes

Gut, 2021-11, Vol.70 (Suppl 4), p.A104-A106 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 0017-5749 ;EISSN: 1468-3288 ;DOI: 10.1136/gutjnl-2021-BSG.194

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  • Title:
    PWE-4 Clinic non-attendance in alcohol-related liver disease is very common, and linked to poorer 1-year outcomes
  • Author: Gordon, Neil ; Gao-Du, Yuxiang ; Hicks, Amy ; Corless, Lynsey
  • Subjects: Alcohol ; Drinking behavior ; Liver diseases ; Mortality ; Patients ; Survival
  • Is Part Of: Gut, 2021-11, Vol.70 (Suppl 4), p.A104-A106
  • Description: IntroductionMortality following acute decompensation (AD) of alcohol-related chronic liver disease remains high despite significant advances in in-patient therapeutics and supportive care. Ongoing specialist support is recommended for all survivors and yet many patients are lost to follow up over time, potentially impacting outcomes. We retrospectively analysed a cohort of patients who survived an AD event and were offered specialist clinic follow up in our centre.MethodsElectronic records were reviewed for all patients surviving an admission for AD and offered rapid local follow up (within 4 weeks), from January 2016 to December 2017. Demographic data, clinic attendances and clinical course (Child-Pugh/MELD scores at 1, 3, 6, and 12 months) were recorded, as well as 1-year mortality and abstinence rates.Results129 unique patients were included (32% female; 68% male), with median age 53 (range 29-83). Mortality was 24% (n=31) at 1 year, in keeping with published cohorts. Of these, 55% (n=17) were directly attributable to liver disease. At 3 years mortality reached 51% (n=66), with approximately half (48%; n=32) due to a liver cause. 91 AD survivors (71%) attended their initial appointment (non-attendance rate 29%). 1 year mortality was significantly lower in this group compared to non-attenders [18 (20%) v 14 (38%), p=0.03]. This was reflected in a downward trend in mean MELD scores for attenders at 1, 3, 6 and 12 months (15, 15, 14 and 12 respectively), whereas non-attenders showed static or worsening disease (14, 15, 17, 14). Similarly, Child-Pugh (CP) scores showed significantly greater numbers of attenders recompensated to CP-A by 12 months [29 (32%) v 5 (16%), p=0.033]. Nearly half (47%; n=60) of all patients were still drinking alcohol at 1 year. However, those who attended the first appointment were significantly more likely to be abstinent at 1 year than those who did not [42 (46%) v 6 (16%), p=0.002], which is considered the most likely reason for better 1-year survival in this group.ConclusionsOur results show that poor initial engagement with follow up is very common, and is associated with lower rates of abstinence, recompensation, and survival at 1 year. There are likely to be many reasons patients cannot or do not attend. Exploring these factors - and identifying ways to promote engagement - should be considered a high priority to improve longer-term outcomes.
  • Publisher: London: BMJ Publishing Group Ltd and British Society of Gastroenterology
  • Language: English
  • Identifier: ISSN: 0017-5749
    EISSN: 1468-3288
    DOI: 10.1136/gutjnl-2021-BSG.194
  • Source: ProQuest Central
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