The impact of specialist management of jaundiced alcoholic liver disease patients.
BACKGROUND
Patients with alcoholic liver disease (ALD) presenting with jaundice have advanced chronic ALD and/or acute alcoholic hepatitis. Their prognosis is poor. These patients may be managed by General Medical physicians (GM) or by Gastroenterologists (GE).


OBJECTIVE
This study aimed to retrospectively assess the differences in management and outcome of jaundiced ALD between GM and GE.


METHODS
Patients with a serum bilirubin greater than 80 mmol/l on admission and a history of alcohol excess until within three weeks of admission were identified retrospectively. In particular the use of corticosteroids (CS), nutritional support (N) and the use of broad-spectrum antibiotics (A/b) were noted.


RESULTS
97 patients were identified, 62 managed by GE. Differences were apparent between GE and GM managed patients with respect to CS (p = 0.017), N (p < 0.001) and A/b (p < 0.001). The overall mortality was 27.8%, 34.0%, and 37.1% at 28, 56, and 84 days respectively. Mortality for patients with a Discriminant Function approximately 32 was greater in GM managed patients compared with GE at 28 (p = 0.006), 56 (p = 0.013), and 84 days (p = 0.036).


CONCLUSIONS
Differences exist between the management of jaundiced ALD between GM and GE. Such differences may translate into improved outcomes.
Forrest
E H
EH
Department of Gastroenterology, Victoria Infirmary, Glasgow. Ewan.Forrest@gvic.scot.nhs.uk
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005194:Family Practice; D005260:Female; D005762:Gastroenterology; D006519:Hepatitis, Alcoholic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007565:Jaundice / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents