CirrhoCare®-a pilot study of digital home management of advanced cirrhosis to determine feasibility and utility to diagnose new decompensation events

ABSTRACT

Background and AimsPatients discharged from hospital following acute decompensation are at high risk of new complications and need close follow-up, limited currently by the growing burden of cirrhosis and impact of COVID-19. Specialist liver care in the community is an unmet need, to reduce hospital exposure and manage new decompensation events.MethodsWe included 20 patients with cirrhosis and recent acute decompensation. Commercially available devices and a smartphone (+SIM card) were given to all patients for daily recording of ECG, blood pressure, weight, and% body-water (bioimpedance), Stroop test (hepatic encephalopathy (HE) assessment), and self-reported well-being and food/fluid/alcohol intake. Data was Blue-toothed via a secure server to the CirrhoCare®-App, which had 2-way patient-physician communication. Hepatologists evaluated daily data and facilitated interventions as required. A matched control cohort (n=20) with advanced cirrhosis was observed in parallel.ResultsPatient demographics Mean age 59±10 years, 14 male, main etiology alcohol (75%);75% Child-Pugh class B. Fifteen patients (75%) showed good compliance, (≥4 readings/week), 2 had moderate compliance (2–4/week), and 3 had poor compliance (<2/week). In a usability questionnaire scored 1–10, the median score was ≥9 for any given question.Mean follow-up was 10.1±2.4 weeks. Amongst CirrhoCare® managed patients, 1 died and 1 received a liver transplant. Eight readmissions occurred in 5 different patients 3 due to HE, 1 to acute-kidney injury (AKI), 1 to both AKI and HE, and 3 in the same patient to rectal bleeding. The median readmission lasted 5 (IQR 3.5–11) days, and none was >14 days. Except for the acute bleeds, we identified early signs of decompensation in all cases, e.g. failed Stroop test, hypotension or reduction/gain in body fluid (weight), and facilitated 2 short hospitalizations of the 8 total readmissions.Based on early signs of decompensation, we contacted patients on 16 other occasions, guiding intervention and likely preventing further readmissions as confirmed by an independent physician panel. Two controls died during follow-up, and there were 13 readmissions in 8 patients, lasting median 7 (IQR 3–15) days with four admissions >14 days. They had 6 unplanned paracenteses compared to 1 in CirrhoCare®-managed patients.ConclusionsCirrhoCare®’s novel, multimodal, home-monitoring in patients with advanced cirrhosis is feasible with excellent patient engagement, and prompts early diagnosis of decompensating events and their intervention;and hospital admissions are fewer and shorter in duration than in controls. We propose the application of CirrhoCare® for assisted, specialist, community management of advanced cirrhosis.