Five-year outcomes of a dedicated, multidisciplinary clinic for decompensated cirrhosis.

BACKGROUND

Novel models of ambulatory care have been used in chronic disease management, but implementation in advanced chronic liver disease remains limited.

AIMS: We aimed to explore clinical outcomes of a multidisciplinary clinic for patients with chronic liver disease.

METHODS

We performed a retrospective cohort study of patients attending a multidisciplinary liver clinic between February 2019 and May 2024. The clinic comprised co-located hepatologists, a dietitian, a pharmacist and an addiction medicine specialist, coordinated by a hepatology nurse. Patients accessed on-site point-of-care ultrasound, abdominal paracentesis and albumin infusions. The primary outcome was liver-related admission. Secondary outcomes were 12-month admission-free survival and change in liver disease prognostic scores at 3 and 6 months.

RESULTS

A total of 285 patients were included, of whom 61% were men, 56% had alcohol-related liver disease and 95% had cirrhosis. The median baseline model for end-stage liver disease (MELD) score was 14.6 (interquartile range (IQR): 10.6-18.9) and 52% were in Child-Pugh B class at index appointment. The liver-related admission rate was 33% at a median of 546 days (IQR: 149-1095 days) from index appointment, and 12-month admission-free survival was 40.4% (IQR: 34.6-46.1). Median MELD improved at 3 months (12.8 months (IQR: 9.8-15.9 months), P < 0.05) and plateaued by 6 months (11.9 months (IQR: 9.4-16.2 months), P = 0.29). The proportion of patients with ascites decreased at each time point (54% vs 35% vs 27%, P < 0.05).

CONCLUSIONS

Two-thirds of patients attending a multidisciplinary liver clinic had no subsequent liver-related admissions, with a median 18-month latency to admission in the remainder. Co-location of clinicians and supportive measures may contribute to these findings.