Patient with hepatic cirrhosis: management strategy according to national clinical guidelines and real clinical practice. Results of a retrospective cohort study

Background. The immediate causes of death in patients with hepatic cirrhosis (HC) include infectious complications, hepatic encephalopathy (HE), and variceal hemorrhage. In real clinical practice, low adherence to the medical care quality criteria for this complex population of patients remains, which cannot but affect the results of treatment. Objective. Optimization of the management tactics for HC patients based on assessment of practitioners’ adherence to national clinical guidelines and their compliance with the medical care quality criteria. Methods. A retrospective cohort study based on a review of 589 medical records of patients with HC who were examined and treated in outpatient and inpatient settings in 2015-2020 at the Central Hospital of the Krasnodar Territory was conducted. Medical records of outpatients and medical records of inpatients with HC complications and receiving drug therapy were reviewed. Results. The most frequent HC complications were ascites (in 51.8% of patients) and variceal hemorrhage (in 26.1%). At the outpatient stage, control of the water-electrolyte balance was carried out only in 134 (66.7%) patients with ascites, adequate diagnostic measures were carried out for 65 (77.3%) patients with clinically significant HE, 19 (22.6%) patients did not receive course therapy in the presence of clinical manifestations of HE. Screening esophagogastroduodenoscopies at the outpatient stage were regularly performed in only 61.5% of patients with clinically significant portal hypertension. At the inpatient stage, adherence to the medical care quality criteria for patients with ascites did not exceed 76.9%, with spontaneous bacterial peritonitis - 2.6%, HE - 73.0%; in case of diagnosing and treating variceal hemorrhage it ranged from 4.2% to 94.4%. Conclusion. The study revealed a number of errors in the management tactics of patients with HC at the outpatient and inpatient stages of medical care, affecting the results of treatment.

hepatic cirrhosis, hepatic encephalopathy, variceal hemorrhage, ascites, medical care quality criteria