Scottish medical journal · 2004
The impact of specialist management of jaundiced alcoholic liver disease patients.
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Forrest E H
Аннотация
BACKGROUND: Patients with alcoholic liver disease (ALD) presenting with jaundice have advanced chronic ALD and/or acute alcoholic hepatitis. Their prognosis is poor. These patients may be managed by General Medical physicians (GM) or by Gastroenterologists (GE).
AIM: This study aimed to retrospectively assess the differences in management and outcome of jaundiced ALD between GM and GE.
PATIENTS AND METHODS: Patients with a serum bilirubin greater than 80 mmol/l on admission and a history of alcohol excess until within three weeks of admission were identified retrospectively. In particular the use of corticosteroids (CS), nutritional support (N) and the use of broad-spectrum antibiotics (A/b) were noted.
RESULTS: 97 patients were identified, 62 managed by GE. Differences were apparent between GE and GM managed patients with respect to CS (p = 0.017), N (p < 0.001) and A/b (p < 0.001). The overall mortality was 27.8%, 34.0%, and 37.1% at 28, 56, and 84 days respectively. Mortality for patients with a Discriminant Function approximately 32 was greater in GM managed patients compared with GE at 28 (p = 0.006), 56 (p = 0.013), and 84 days (p = 0.036).
CONCLUSION: Differences exist between the management of jaundiced ALD between GM and GE. Such differences may translate into improved outcomes.
AIM: This study aimed to retrospectively assess the differences in management and outcome of jaundiced ALD between GM and GE.
PATIENTS AND METHODS: Patients with a serum bilirubin greater than 80 mmol/l on admission and a history of alcohol excess until within three weeks of admission were identified retrospectively. In particular the use of corticosteroids (CS), nutritional support (N) and the use of broad-spectrum antibiotics (A/b) were noted.
RESULTS: 97 patients were identified, 62 managed by GE. Differences were apparent between GE and GM managed patients with respect to CS (p = 0.017), N (p < 0.001) and A/b (p < 0.001). The overall mortality was 27.8%, 34.0%, and 37.1% at 28, 56, and 84 days respectively. Mortality for patients with a Discriminant Function approximately 32 was greater in GM managed patients compared with GE at 28 (p = 0.006), 56 (p = 0.013), and 84 days (p = 0.036).
CONCLUSION: Differences exist between the management of jaundiced ALD between GM and GE. Such differences may translate into improved outcomes.