Gastrounit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.
Clinical Research Department, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.
PLoS One. 2023 Feb 9;18(2):e0278545. doi: 10.1371/journal.pone.0278545. eCollection 2023.
Liver cirrhosis represents a considerable health burden and causes 1.2 million deaths annually. Patients with decompensated liver cirrhosis have a poor prognosis and severely reduced health-related quality of life. Nurse-led outpatient care has proven safe and feasible for several chronic diseases and engaging nurses in the outpatient care of patients with liver cirrhosis has been recommended. At the decompensated stage, the treatment and nursing care are directed at specific complications, educational support, and guidance concerning preventive measures and signs of decompensation. This review aimed to assess the effects of nurse-assisted follow-up after admission with decompensation in patients with liver cirrhosis from all causes.
A systematic search was conducted through February 2022. Studies were eligible for inclusion if i) they assessed adult patients diagnosed with liver cirrhosis that had been admitted with one or more complications to liver cirrhosis and ii) if nurse-assisted follow-up, including nurse-assisted multidisciplinary interventions, was described in the manuscript. Randomized clinical trials were prioritized, but controlled trials and prospective cohort studies with the intervention were also included. Primary outcomes were mortality and readmission, but secondary subjective outcomes were also assessed.
We included eleven controlled studies and five prospective studies with a historical control group comprising 1224 participants. Overall, the studies were of moderate to low quality, and heterogeneity across studies was substantial. In a descriptive summary, the 16 studies were divided into three main types of interventions: educational interventions, case management, and standardized hospital follow-up. We saw a significant improvement across all types of studies on several parameters, but currently, no data support a specific type of nurse-assisted, post-discharge intervention. Controlled trials with a predefined intervention evaluating clinically- and practice-relevant endpoints in a real-life, patient-oriented setting are highly warranted.
肝硬化是一个重大的健康负担，每年导致 120 万人死亡。失代偿期肝硬化患者预后不良，健康相关生活质量严重下降。护士主导的门诊护理已被证明对多种慢性病是安全且可行的，因此建议让护士参与肝硬化患者的门诊护理。在失代偿期，治疗和护理针对特定的并发症、教育支持以及预防措施和失代偿迹象的指导。本综述旨在评估针对所有病因导致的肝硬化失代偿患者住院后接受护士辅助随访的效果。
系统检索截至 2022 年 2 月的文献。如果研究：i）评估成人肝硬化患者，这些患者被诊断为患有肝硬化，且因一种或多种并发症而住院；ii）在研究报告中描述了护士辅助随访，包括护士辅助多学科干预，那么这些研究符合纳入标准。我们优先考虑随机临床试验，但也纳入了对照试验和有干预措施的前瞻性队列研究。主要结局是死亡率和再入院率，但也评估了次要的主观结局。
共纳入 11 项对照研究和 5 项前瞻性研究，其中包括 1224 名参与者的历史对照研究。总体而言，这些研究的质量为中等至较低，且研究之间存在很大的异质性。在描述性总结中，这 16 项研究分为三种主要干预类型：教育干预、病例管理和标准化医院随访。我们在所有类型的研究中都看到了多个参数的显著改善，但目前没有数据支持特定类型的护士辅助、出院后干预。在现实环境中，以患者为导向，针对具有临床和实践相关性的结局进行预定义干预的对照试验是非常需要的。
