Abstract

Cirrhosis carries high morbidity and mortality due to various complications and decompensation, which can be decreased by following various practice guidelines, which are variedly followed in actual practice. This multicentric prospective/retrospective study was conducted over a 3 month period to assess actual care of patients with cirrhosis. 416 patients with cirrhosis (median age 53 years, 316 males) were included in the study. A comprehensive protocol was devised taking into account various practice guidelines. Patients were divided into 3 groups. Group 1: Newly diagnosed patients evaluated as per protocol. Group 2: Patients previously diagnosed at the study centers, past practices assessed. Group 3: patients diagnosed previously at non-study centers, their surveillance practices were assessed. Patients in the 3 groups were similar in terms of age and gender ratio. There was significant difference between varices screening practices amongst 3 groups, however there was similar nonselective beta blockers (NSBB)/endoscopic variceal ligation (EVL) prophylaxis practices. Ultrasound surveillance for ascites varied significantly amongst 3 groups. There was significant difference between antibiotic prophylaxis practice in high risk ascites patients between groups 1 and 2. Evaluation of renal function at baseline and ultrasound surveillance for hepatocellular carcinoma was significantly different in 3 groups. All patients in group 1 underwent SpO2 monitoring, however none in groups 2 or 3 previously had SpO2 monitoring. Surveillance and treatment practices for various complications of cirrhosis vary widely in real life and falls well short of goals. Presence of dedicated protocols helps in improving the way we care for our patients with cirrhosis.

Key words: Portal hypertension, varices, ascites, hepatocellular carcinoma (HCC), surveillance