PWE-129 Decompensated alcohol related liver disease – how well are we serving our patients?

Abstract

<h3>Introduction</h3> Scotland has one of the highest alcohol consumption in the world resulting in significant burden on the NHS. 36206 admissions in Scottish Hospital in 2013 were related to alcohol and 1:6 had Alcohol Related Liver Disease (ARLD).¹SIGN guidelines along with BSG, BASL and RCP joint position paper on ARLD recommend that all patients with alcohol related physical disorder should be seen by specialist alcohol services.^2,3In Aberdeen Royal Infirmary all patients with decompensated ARLD are managed in the Digestive Disorders Unit. <h3>Method</h3> We prospectively collected data on all patients admitted to our unit between 01/05/14 and 31/12/14. Demographics, presenting symptoms, treatment, progress, complications and outcomes were analysed with descriptive statistics. <h3>Results</h3> 94 patients with ARLD were admitted (30 first presentation) on 155 occasions. Male to Female ratio was 5:2, mean age of 55 ± 11 years. The mean length of stay was 15.7 ± 13 days, median 8 days. The primary reason for admission was control of ascites (33%), jaundice (19%), encephalopathy (13%) and upper GI bleeding (13%). 83%(78/94) had ongoing alcohol dependency. 23% (7/30) of new patients died during their first admission. 58/94(62%) patients had Ascites, 19/94(20%) had SBP. We performed 86 large volume paracenteses and 51 gastroscopies. Encephalopathy was present in 57(37%) and HRS in 37(24%) of the 155 admissions. Dieticians reviewed 28/30(93%) new and 71/94(76%) of all patients with 38/94(32%) requiring NG feeding. We referred 36/78(45%) dependent patients to Integrated Alcohol Service, 17 accepted.5 were seen in 2 to 7 months post discharge.1 patient was seen in less than 3 weeks from referral.2 people referred to the drop in clinic didn’t attend. <h3>Conclusion</h3> ARLD is the single most common cause of unscheduled admissions to our service. Despite nutritional support and judicious use of antibiotics, Human Albumin Solution and vasopressors, there continues to be a significant readmission rate and mortality in this group. During the study period there was no inpatient Alcohol Liaison Service which may be relevant. A minority of those referred to the Integrated Alcohol Service were seen. Numerous reasons account for failure to attend out-patient alcohol services but it is clear that a more robust system to tackle long-term alcohol dependency and recidivism is required. A structured outpatient follow up clinic and alcohol services in the future will help improve the outcomes for these patients. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Alcohol-related Hospital Statistics Scotland. 2012/13 -25Feb14 SIGN guidelines N74. 2003 Moriarty, KJ. Alcohol related disease: meeting the challenge of improved quality of care and better use of resources;2010. Joint Position Paper by BSG/BASL/AHA