دورية أكاديمية
Full adherence to cirrhosis quality indicators is associated with lower mortality in acute variceal bleeding: Nationwide audit.
| العنوان: | Full adherence to cirrhosis quality indicators is associated with lower mortality in acute variceal bleeding: Nationwide audit. |
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| المؤلفون: | Wong YJ; Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.; Duke-NUS Academic Clinical Program, SingHealth, Singapore.; Liver unit, Division of Gastroenterology & Hepatology, University of Alberta, Canada., Teng M; Division of Gastroenterology and Hepatology, National University Hospital, Singapore., Sim A; Department of Gastroenterology & Hepatology, Tan Tock Seng General Hospital, Singapore., Thet HM; Department of Medicine, Division of Gastroenterology & Hepatology, Ng Teng Fong Hospital, Singapore., Teoh X; Department of General Medicine, Division of Gastroenterology, Khoo Teck Puat Hospital, Singapore., De Roza MA; Department of Gastroenterology & Hepatology, Sengkang General Hospital, Singapore., Sen Kew G; Department of Medicine, Woodlands Health, Singapore., Koh JH; Division of Gastroenterology and Hepatology, National University Hospital, Singapore., Loi PL; Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore., Lim K; Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore., Kang G; Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore., Kuang J; Department of Gastroenterology & Hepatology, Tan Tock Seng General Hospital, Singapore., Low EXS; Department of Medicine, Division of Gastroenterology & Hepatology, Ng Teng Fong Hospital, Singapore., Ho JL; Department of Medicine, Woodlands Health, Singapore., Cher LYG; Department of General Medicine, Division of Gastroenterology, Khoo Teck Puat Hospital, Singapore., Sze K; Department of General Medicine, Division of Gastroenterology, Khoo Teck Puat Hospital, Singapore., Wong GW; Department of Medicine, Division of Gastroenterology & Hepatology, Ng Teng Fong Hospital, Singapore., Kwek BYA; Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.; Duke-NUS Academic Clinical Program, SingHealth, Singapore., Yang WL; Department of Gastroenterology & Hepatology, Tan Tock Seng General Hospital, Singapore., Abraldes JG; Liver unit, Division of Gastroenterology & Hepatology, University of Alberta, Canada., Chang J; Duke-NUS Academic Clinical Program, SingHealth, Singapore.; Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore. |
| المصدر: | Hepatology (Baltimore, Md.) [Hepatology] 2024 Feb 20. Date of Electronic Publication: 2024 Feb 20. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | 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 |
| أسماء مطبوعة: | Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc. Original Publication: Baltimore, MD : Williams & Wilkins, [c1981]- |
| مستخلص: | 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.) |
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| تواريخ الأحداث: | Date Created: 20240221 Latest Revision: 20240322 |
| رمز التحديث: | 20240322 |
| DOI: | 10.1097/HEP.0000000000000793 |
| PMID: | 38381716 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1527-3350 |
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| DOI: | 10.1097/HEP.0000000000000793 |