S1067 A Retrospective Review: Are We Adequately Screening for Important Outcome Predictors in Pre-Transplant Cirrhotic Patients?

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INTRODUCTION: The number of US patients requiring liver transplantation continues to rise. Insufficient screening for alcohol use, nutritional deficiency, sexual dysfunction, and frailty can adversely affect patient outcomes. This study evaluated whether ESLD patients were being adequately screened for important outcome predictors during hospital admission via the hepatology checklist for liver transplantation candidacy. METHODS: A retrospective analysis from July 2017 through September 2018 was conducted on an inpatient hepatology service at a single academic tertiary care center. Hospitalized patients with a diagnosis of cirrhosis and an active hepatology consult were included. Post-liver transplant patients or those with hepatocellular carcinoma were excluded. Data was analyzed with Stata using univariate and multivariable logistic regression and Fisher’s exact test. RESULTS: A total of 382 records were reviewed, of which 174 met criteria for analysis. 118 were male and the average age of both groups was 52.6 years. 73 out of 174 patients (41.9%) had a diagnosis of alcoholic cirrhosis and 126 out of 174 (72.41%) were screened during hospitalization for alcohol use. Only 34 out of 56 (60.71%) females were screened compared to 92 out of 118 (77.97%) males (P = 0.02). Out of 174 patients, 83 (87.9%) were screened for frailty, of which 73 (87.9%) had a physical therapy consult. 58.6% of patients received an inpatient nutrition consult and only 4 patients out of 174 (2.3%) were screened for sexual dysfunction. CONCLUSION: This study suggests that the prevalence of patients screened for important outcome predictors is lacking. Despite alcoholic cirrhosis accounting for nearly half of our cirrhotic population, our institution is under-recognizing patients that would benefit from focused screening for alcoholism. Screening was significantly higher for male patients compared to females showing a gender disparity in screening. Standardized screening criteria must be systematically evaluated and administered in the ESLD population, particularly in overlooked patient populations. Improved interviewing strategies and checklist optimization are crucial to identifying high-risk patients who may be liver transplant candidates. This allows for more effective alcohol cessation, nutritional and physical optimization and management of sexual dysfunction prior to liver transplant evaluation and should be implemented at all institutions in a standardized manner. In this way, overall outcomes and prognoses may be improved.Table 1.: Patient Characteristics.