Abstract
Improved Survival Outcomes in Cirrhotic Patients with Acute Variceal Bleeding Following Full Adherence to Clinical Practice Guideline (CPG) Quality Metrics: A Retrospective Cohort Study
Laurence H. Laurel, MD; Tonee Ann Abella, MD; Jovito Balbosa, MD; Suzette Kho-Herman, MD; Ian Homer Cua, MD
St. Luke’s Medical Center – Global City
Significance: Acute variceal bleeding (AVB) is a life-threatening complication of liver cirrhosis with a 6-week mortality rate of 20%. The 2024 AASLD guidelines recommend evidence-based interventions, including use of vasoactive agents, prophylactic antibiotics, nonselective beta-blockers (NSBBs), timely endoscopy and variceal band ligation, to improve patient outcomes. Evidence on the impact of full guideline adherence in our setting is limited, hence, our study evaluates whether full adherence to these guidelines enhances survival in cirrhotic patients with acute variceal bleeding.
Methodology: A retrospective cohort study was conducted at St. Luke’s Medical Center-Global City (2018–2023) involving 105 cirrhotic patients with AVB. Adherence was evaluated based on five CPG quality metrics: prophylactic antibiotics, use of somatostatin analogues, timely endoscopy (within 12 hours), endoscopic hemostasis, and NSBB administration. The primary outcome was 6-week mortality, with secondary outcomes included early infection, rebleeding rates, acute-on-chronic liver failure (ACLF), and 1-year mortality.
Results: A total of 105 patients were included in the study, with baseline characteristics similar between the full adherence versus suboptimal adherence groups. Full adherence was associated with a significant reduction in 6-week mortality (10.6% vs. 25.9%; OR = 0.34, 95% CI: 0.11–1.0, p = 0.0493), lower early infection rates (23.4% vs. 32.8%), and ACLF events (6.4% vs. 8.6%). While 1-year mortality was lower (23.4% vs. 36.2%), it was not statistically significant (p = 0.1584). Advanced liver disease (Child-Pugh C or MELD-Na ?15) remained a predictor of poor outcomes despite full adherence to CPG quality metrics.
Conclusion: Full adherence to CPG quality metrics significantly reduces 6-week mortality and complications in AVB, this serve as a benchmark for improving quality care in cirrhotic patients.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |