PTH-069 Alcohol and liver diseases: recognition and impact on admissions in a district general hospital

Abstract

Introduction Self reported alcohol intake in the 2005 UK census suggests that 38% of men and 18% of women drink an average of >20 g of alcohol per day. The recently published National Plan for Liver Services in the UK1 documents the increasing problem of alcohol and liver related diseases and recommends that all UK district general hospitals should have hepatologists and alcohol services on site. Methods We assessed the burden of alcohol and liver related admissions in a busy DGH by examining a random sample of case notes of adult general medical and surgical admissions over a 7-day period. Stroke, elderly care, obstetric and paediatric wards were excluded. An Alcohol Attributable Fraction (ICD-10 figures) was calculated for each case according to primary and secondary diagnoses. Results Our hospital is a typical DGH with 596 beds (60% medicine), with an average of 70 patients admitted per day for average of 9 days. At the time of the audit there was no dedicated alcohol liaison service. Notes were reviewed for 246 patients (143 medicine, 37 surgery, 66 orthopaedics: 111 male, 135 female). An alcohol history (simple yes/no) was documented in 120 (49%) and smoking history in 137 (56%). Any more thorough alcohol history (eg, occasional, binge or units) was documented in only 52 (21%). A history of illicit drug use was documented in 1 (0.4%). The primary diagnosis was reported as directly alcohol related in 12 (5%) (alcohol related liver disease/cirrhosis 10; head injury while intoxicated 2) and liver related in 1 (0.4%, cryptogenic cirrhosis). Less overt diagnoses associated with alcohol were either not recognised or reported, none being documented in medical notes. The mean Alcohol Attributable Fraction for admission diagnoses was 8.0%, or 12.4% when including all those with a fall/fracture as per ICD-10 classification. Documentation of referral to alcohol services was found in 5 (42% of those recognised as alcohol related). Hepatitis or metabolic liver disease were not causes for admission (0%). 29 (12%) of non-liver related admissions had abnormal liver biochemistry. Of these, 13 (45%) had evidence of further investigation for a cause (ultrasound, hepatitis, autoantibody and/or metabolic screen). Conclusion Alcohol associated illness is a common cause of hospital admission (Alcohol Attributable Fraction 8%–12%) but recognition and documentation of alcohol use is poor. Hepatitis and metabolic liver diseases are uncommon reasons for admission. Better recognition, implementation of brief intervention strategies and/or referral to alcohol services may reduce the predicted future harmful impact of alcohol on personal and public health.