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Cirrhosis Deaths Drop 41% from 2002 to 2012

But patients continue to have higher sepsis risk, authors find

A new study by researchers at the University of North Carolina has found dramatic improvements in the survival of patients with cirrhosis and liver failure, supporting improved treatment strategies for patients with cirrhosis and concurrent bacterial infections.

The study analyzed more than 780,000 hospitalizations of patients with cirrhosis from 2002 to 2010 and found that inpatient mortality decreased steadily during that period despite increases in patient age and the need for more complex medical care. The study used the Health Care Cost and Utilization Project National Inpatient Sample, the largest sampling of U.S. hospitals to date.

The study was published in the May 2015 issue of Gastroenterology.

“While the number of cirrhosis hospitalizations increased during the sample period, the rate of hospital deaths fell by 41%,” said lead author Monica Schmidt, MPH. “In addition, the decline in mortality for cirrhosis patients dropped significantly compared to non-cirrhotic patients. Increased awareness of disease management and earlier diagnosis for cirrhosis-related complications may have led to better survival rates.”

 “These data are encouraging because there has been a lot of research effort put into improving inpatient cirrhosis care over the years, and it appears it may be paying off,” said coauthor Paul H. Hayashi, MD, MPH.

Cirrhosis is the eighth-leading cause of death in the U.S. and often requires hospitalization for complications, which can include bleeding, confusion, cancer, and susceptibility to bacterial infections.

Cirrhosis-related admissions to hospitals continue to grow, according to the authors. Care of cirrhosis patients is complex and often managed by a team of gastroenterologists, hepatologists, intensivists, and nephrologists. The study targeted all causes and forms of liver cirrhosis.

While the decline in patient deaths was good news, the study found that cirrhosis patients do much worse than other patients with sepsis. The mortality risk for infections actually increased over time, despite the ongoing “surviving sepsis” campaign. The increased risk for cirrhosis patients may be related to abnormal blood-flow issues and immune responses that could hinder survival, the authors said.

The study suggests that improving cirrhosis care may be leading to better overall survival, but notes that rising mortality risks for sepsis suggest that a more tailored approach is needed for treating sepsis in patients with cirrhosis. The authors suggest that their data can help in setting appropriate quality care indicators and guideline use, as well as in determining adjusted mortality risk and the use of palliative care.

Source: University of North Carolina; April 22, 2015.

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