Five-year outcomes of a dedicated, multidisciplinary clinic for decompensated cirrhosis

Novel models of ambulatory care have been used in chronic disease management, but implementation in advanced chronic liver disease remains limited.

We aimed to explore clinical outcomes of a multidisciplinary clinic for patients with chronic liver disease.

We performed a retrospective cohort study of patients attending a multidisciplinary liver clinic between February 2019 and May 2024. The clinic comprised co-located hepatologists, a dietitian, a pharmacist and an addiction medicine specialist, coordinated by a hepatology nurse. Patients accessed on-site point-of-care ultrasound, abdominal paracentesis and albumin infusions. The primary outcome was liver-related admission. Secondary outcomes were 12-month admission-free survival and change in liver disease prognostic scores at 3 and 6 months.

A total of 285 patients were included, of whom 61% were men, 56% had alcohol-related liver disease and 95% had cirrhosis. The median baseline model for end-stage liver disease (MELD) score was 14.6 (interquartile range (IQR): 10.6-18.9) and 52% were in Child-Pugh B class at index appointment. The liver-related admission rate was 33% at a median of 546 days (IQR: 149-1095 days) from index appointment, and 12-month admission-free survival was 40.4% (IQR: 34.6-46.1). Median MELD improved at 3 months (12.8 months (IQR: 9.8-15.9 months), P < 0.05) and plateaued by 6 months (11.9 months (IQR: 9.4-16.2 months), P = 0.29). The proportion of patients with ascites decreased at each time point (54% vs 35% vs 27%, P < 0.05).

Two-thirds of patients attending a multidisciplinary liver clinic had no subsequent liver-related admissions, with a median 18-month latency to admission in the remainder. Co-location of clinicians and supportive measures may contribute to these findings.