Use of a cirrhosis database can positively impact patient care in United Kingdom practice

ABSTRACT

Background and aims: Screening for oesophageal varices and surveillance for hepatocellular carcinoma (HCC) are advised for patients with cirrhosis but adherence to recommendations is poor. The study aimed to provide descriptive analysis of a new cirrhosis database and evaluate rates of surveillance in a large teaching hospital. Method: All patients diagnosed with advanced fibrosis/cirrhosis in our centre entered the database sequentially from April 2018. The service covers a population of 600000, with expected prevalence of 600 cirrhotic patients. The database-rather than clinic visits-became the primary means to monitor HCC surveillance/endoscopic screening requests. Subsequent adherence to recommendations was measured in 2021. Results: 841 patients entered the database over 3 years, with only 200 at inception-less than the predicted cirrhosis prevalence. 36 people died during follow-up and 5 left the area. Of the remaining 800 patients, median age was 60 years;40% female. 46% of patients had alcohol related disease, 21% non-alcoholic fatty liver disease, 14% viral hepatitis. 63% of the cohort had Childs-Pugh (CP) A or advanced fibrosis, 14% CP-B, 3% CP-C. 21% had no stage recorded. 157 patients (20%) were on primary prophylaxis for variceal bleeding. Of the remaining 643 patients, 237 (37%) were on active endoscopic surveillance and a further 100 (16%) had attended endoscopy in the past 3 years. 43 patients (7%) were overdue, 40 (6%) declined, and 30 (5%) had documented clinical decision not to proceed. 191 patients (24%) had no documentation about screening. 603 (78%) of appropriate patients were up to date with HCC surveillance with a further 105 (14%) awaiting scan, significantly more than our historically reported adherence of 50% (p = <0.0001). Conclusion: The database improved our knowledge of clinical characteristics of our patient population, and provided a way to readily monitor surveillance intervals. Most had appropriate HCC surveillance, surpassing our previous (or nationally reported) adherence rates. A quarter of patients had no documentation of variceal screening, highlighting an area for improvement. Given the rapid rise in cohort size, it is likely the database also reduces numbers lost to follow-up/surveillance in the event of clinic non-attendance, which may be particularly valuable in the post-Covid era of delayed appointments. This study shows the potential of a registry to improve care and outcomes in people with cirrhosis