Appropriate and Potentially Inappropriate Medication Use in Decompensated Cirrhosis

Thomson, Mary; Lok, Anna S.; Tapper, Elliot B.

doi:10.1002/hep.31548

Cited by 28 publications

(32 citation statements)

References 24 publications

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“…(11,22) These metrics are unlikely to benefit from further intervention. In contrast, Kardashian et al also found that 2% of patients with recent variceal hemorrhage underwent timely repeat procedures for variceal obliteration, and Thomson et al (20) showed that, although many patients received β-blockade, most did not refill their medication. (11)…”

Section: Quantifying Performance Gapsmentioning

confidence: 97%

The Future of Quality Improvement for Cirrhosis

Tapper

Parikh

2021

Liver Transpl

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Cirrhosis has a significant and growing impact on public health and patient-reported outcomes (PROs). The increasing burden of cirrhosis has led to an emphasis on the quality of care with the goal of improving overall outcomes in this high-risk population. Existing evidence has shown the significant gaps in quality across process measures (eg, hepatocellular carcinoma screening), highlighting the need for consistent measurement and interventions to address the gaps in quality care. This multistep process forms the quality continuum, and it depends on clearly defined process measures, real-time quality measurement, and generalizable evaluative methods. Herein we review the current state of quality care in cirrhosis across the continuum with a focus on process measurement methodologies, developments in PRO evaluation on quality assessment, practical examples of quality improvement initiatives, and the recent emphasis placed on the value of primary prevention.

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Section: Quantifying Performance Gapsmentioning

confidence: 97%

The Future of Quality Improvement for Cirrhosis

Tapper

Parikh

2021

Liver Transpl

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“…While a relevant number of patients were not treated according to current guidelines depending on the underlying decompensating event, adherence was numerically higher in the German primary care population when compared to a recently published US cohort [4]. Notably, the use of opioids was numerically lower, with 9.5 % in the German cohort vs. 53.2 % in the US cohort, while NSAIDs, benzodiazepines, and PPIs prescription showed similar numbers.…”

Section: Discussionmentioning

confidence: 79%

“…Evidence-based pharmacological interventions that have an established benefit in secondary prophylaxis are recommended by international guidelines and published by the respective medical societies [2,3]. A recent analysis of large claims databases in the United States (US) suggested that adherence to guideline recommendations for secondary prophylaxis in patients after a first decompensation event is limited [4]. This is likely to affect the recurrence rates of the decompensating event, increase costs from repeated hospital admissions, and worsen the patient's overall prognosis.…”

Section: Introductionmentioning

confidence: 99%

Prescription rates of common medications in patients with decompensated cirrhosis in Germany

Labenz

Kostev²,

Galle

et al. 2021

Z Gastroenterol

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Background Adequate pharmacological treatment is of pivotal importance to improve prognosis in patients with decompensated liver cirrhosis. We studied the adherence to recommended pharmacological treatments as secondary prevention in cirrhotic patients following a first decompensation in German primary care. Methods Using the Disease Analyzer Database, the current study sample included patients with liver cirrhosis who had an initial diagnosis of a first decompensation event between 2015 and 2018 (index date) and a follow-up time of at least 6 months after the index date. Pharmacological treatments following the 6 months after the index date were studied. Results The study included 1538 patients with a first decompensation event. The frequency of first-time complications of cirrhosis was 60% new onset of ascites, 25% overt hepatic encephalopathy (HE), 3% spontaneous bacterial peritonitis (SBP), and 12% acute variceal bleeding. The adherence to guideline-recommended treatment following the initial decompensation was highest for ascites, with 91.3% of patients receiving diuretics. Non-selective beta-blockers following an event of variceal bleeding were prescribed in 69.1% and lactulose and/or rifaximin in 59.1% after a bout of HE. The frequency of prescriptions of antibiotics after SBP was 60.4%. Potenzially harmful prescribed medications included non-steroidal anti-inflammatory drugs in 15.5%, benzodiazepines in 12.8%, opioids in 9.5%, and proton pump inhibitors in 73.7%. Conclusion Our findings underline the need for intensified efforts to distribute practice guidelines for liver cirrhosis and increase awareness of over-prescribing of potentially harmful medication.

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“…Ascites were the most common complication of cirrhosis (86.5%), followed by hepatic encephalopathy (37.8%), variceal bleeding (17.5%), HRS (6.3%), and SBP (6.1%). 24 Rifaximin was introduced to treat hepatic encephalopathy by reducing ammonia via regulation of the gut microbiome. Dong et al 25 reported that long-term rifaximin treatment reduced the rate of AKI in cirrhosis patients.…”

Section: Discussionmentioning

confidence: 99%

Risk and protective factors of acute kidney injury in decompensated cirrhotic patients with ascites on tolvaptan

et al. 2021

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Background and AimAcute kidney injury (AKI) is a life‐threatening complication of liver cirrhosis. Here, we evaluated the risk factors and characteristics of AKI in cirrhosis.Patients/MethodsThis was a single‐center retrospective study. A total of 199 Japanese patients with decompensated liver cirrhosis (104 men, median age 61 years) were enrolled and received tolvaptan orally. Survival rates and new onset of AKI were monitored, and risk factors were evaluated.ResultsForty‐six patients (23.1%) suffered an AKI complication and exhibited significantly poorer survival (P < 0.01). The rates of hepatic encephalopathy (P < 0.01) and chronic kidney disease (CKD; P = 0.02) were significantly increased in patients with AKI. The rate of proton pump inhibitor (PPI)/H2 blocker treatment (P = 0.04) was significantly lower, whereas that of ascites drainage was significantly higher in the AKI cases (P < 0.01). The AKI risk was significantly increased in patients with hepatic encephalopathy (HR 4.18, 95% CI 1.618–10.771). In contrast, the incidence of AKI was significantly lower in patients with a higher serum albumin level (HR 0.36, 95% CI 0.142–0.914, P = 0.03). Treatment with PPI/H2 blockers (HR 0.30, 95% CI 0.126–0.711, P < 0.01) or kanamycin/rifaximin (HR 0.26, 95% CI 0.075–0.929, P = 0.04) was significantly associated with a reduced risk of AKI development.ConclusionsAKI incidence was increased in patients with decreased liver function and was associated with poor survival. PPI/H2 blocker or kanamycin/rifaximin treatment may reduce the risk of AKI.

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Appropriate and Potentially Inappropriate Medication Use in Decompensated Cirrhosis

Cited by 28 publications

References 24 publications

The Future of Quality Improvement for Cirrhosis

The Future of Quality Improvement for Cirrhosis

Prescription rates of common medications in patients with decompensated cirrhosis in Germany

Risk and protective factors of acute kidney injury in decompensated cirrhotic patients with ascites on tolvaptan

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