Better adherence to components of an acute care bundle improves 90-day mortality from acute decompensated chronic...

To evaluate whether adherence to an acute care bundle (ACB) for decompensated cirrhosis is associated with improved patient outcomes, including 90-day mortality, in an Australian tertiary hospital setting.

This retrospective cohort study included all patients admitted with decompensated cirrhosis between June 2016 and March 2018 at a tertiary metropolitan teaching hospital. ACB adherence was assessed among six domains during the first 24 h of admission. Outcomes included in-hospital, 30- and 90-day mortality, hospital readmission and long-term survival.

A total of 157 admissions from 85 patients were included. Median follow-up was 7 years, during which the overall mortality rate reached 74%. Short-term (30-day) mortality was not significantly associated with ACB adherence. However, 90-day mortality was significantly lower in patients with ≥70% adherence (13.8% vs 25.4%, P < 0.05) and ≥80% adherence (9.7% vs 25.9%, P < 0.01), independent of Model for End-Stage Liver Disease (MELD) score, Child-Pugh class or admitting team. No significant differences were observed in readmission rates or long-term survival.

Greater adherence to ACB components in the first 24 h of admission was associated with improved 90-day mortality in patients with decompensated cirrhosis, regardless of disease severity or admitting service. These findings support the use of the ACB as a pragmatic quality improvement tool. Prospective validation is warranted.