A study evaluating outcomes of a virtual specialist liver cirrhosis clinic

ABSTRACT

Background and aims: Managing patients in a specialist cirrhosis clinic improves survival. The COVID-19 pandemic necessitated the transition to virtual clinics (VC). We aimed to evaluate the clinical impact of VC on survival, admission and decompensation rates in cirrhotic patients managed in a specialist service. Method: We retrospectively analysed cirrhotic patients who had a specialised VC from March to June 2020. Clinical parameters were collected at baseline and 6 months and compared with a cohort of patients reviewed face to face (F2F) in the same specialist cirrhosis clinics from March to June 2019. Patients with COVID-19 were excluded. Results: 143 patients attended for VC, 129 for F2F review. Groups were matched for age, sex, aetiology, and Child Pugh grade (CP). There was no difference at 6 months in survival, change in MELD/UKELD, decompensation or need for ambulatory reviewin all cirrhosis grades combined or CP BandC subgroup alone (p > 0.05) (Table 1). Fewer patients were admitted in the VC vs the F2F group (p = 0.01) but this was not validated in CP BandC subgroup (p = 0.28). Fewer blood tests were ordered for the VC group (p = 0.0001). The VC group had longer delays for ultrasound HCC surveillance (<0.0001) without an increase in new HCC cases.Table Baseline Patient Demographics and 6 months’ outcome (*p < 0.05, **p < 0.01)(Table Presented)Conclusion: VC have not resulted in poorer clinical outcomes, even in patients with decompensated cirrhosis. Access to ambulatory care was still required. Fewer blood tests ordered and completed in the VC group did not result in adverse outcomes and this raises the possibility of cost-saving. urther studies need to confirm the longterm clinical impact and cost-effectiveness of specialist VC in management of cirrhotic patients.