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PWE-129 Decompensated alcohol related liver disease – how well are we serving our patients?
  1. F Moroni,
  2. S McTavish,
  3. B Vijayan,
  4. A Fraser,
  5. A Mukhopadhya,
  6. L McLeman
  1. Digestive Disease Unit, NHS Grampian, Aberdeen, UK

Abstract

Introduction Scotland has one of the highest alcohol consumption in the world resulting in significant burden on the NHS. 36206 admissions in Scottish Hospital in 2013 were related to alcohol and 1:6 had Alcohol Related Liver Disease (ARLD).1SIGN guidelines along with BSG, BASL and RCP joint position paper on ARLD recommend that all patients with alcohol related physical disorder should be seen by specialist alcohol services.2,3In Aberdeen Royal Infirmary all patients with decompensated ARLD are managed in the Digestive Disorders Unit.

Method We prospectively collected data on all patients admitted to our unit between 01/05/14 and 31/12/14. Demographics, presenting symptoms, treatment, progress, complications and outcomes were analysed with descriptive statistics.

Results 94 patients with ARLD were admitted (30 first presentation) on 155 occasions. Male to Female ratio was 5:2, mean age of 55 ± 11 years. The mean length of stay was 15.7 ± 13 days, median 8 days. The primary reason for admission was control of ascites (33%), jaundice (19%), encephalopathy (13%) and upper GI bleeding (13%). 83%(78/94) had ongoing alcohol dependency. 23% (7/30) of new patients died during their first admission. 58/94(62%) patients had Ascites, 19/94(20%) had SBP. We performed 86 large volume paracenteses and 51 gastroscopies. Encephalopathy was present in 57(37%) and HRS in 37(24%) of the 155 admissions. Dieticians reviewed 28/30(93%) new and 71/94(76%) of all patients with 38/94(32%) requiring NG feeding. We referred 36/78(45%) dependent patients to Integrated Alcohol Service, 17 accepted.5 were seen in 2 to 7 months post discharge.1 patient was seen in less than 3 weeks from referral.2 people referred to the drop in clinic didn’t attend.

Conclusion ARLD is the single most common cause of unscheduled admissions to our service. Despite nutritional support and judicious use of antibiotics, Human Albumin Solution and vasopressors, there continues to be a significant readmission rate and mortality in this group. During the study period there was no inpatient Alcohol Liaison Service which may be relevant. A minority of those referred to the Integrated Alcohol Service were seen. Numerous reasons account for failure to attend out-patient alcohol services but it is clear that a more robust system to tackle long-term alcohol dependency and recidivism is required. A structured outpatient follow up clinic and alcohol services in the future will help improve the outcomes for these patients.

Disclosure of interest None Declared.

References

  1. Alcohol-related Hospital Statistics Scotland. 2012/13 -25Feb14

  2. SIGN guidelines N74. 2003

  3. Moriarty, KJ. Alcohol related disease: meeting the challenge of improved quality of care and better use of resources;2010. Joint Position Paper by BSG/BASL/AHA

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