Ngu Natalie L Y, Saxby Edward, Worland Thomas, Anderson Patricia, Stothers Lisa, Hunter Jo, Elford Alexander T, Ha Phil, Hartley Imogen, Roberts Andrew, Seah Dean, Tambakis George, Connoley Declan, Figredo Anita, Ratnam Dilip, Liew Danny, Rogers Benjamin, Sievert William, Bell Sally, Le Suong
Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Gastro Hep Adv. 2024 Oct 18;4(2):100567. doi: 10.1016/j.gastha.2024.10.007. eCollection 2025.
Acute-on-chronic liver failure (ACLF) has a 22%-74% 28-day mortality rate and 30%-40% 30-day readmission rate. We investigated the acceptability and feasibility of a multimodal community intervention for ACLF.
A single-arm nonrandomized pilot study of consecutive participants with ACLF was conducted in a tertiary health service. Participants received weekly medical and nursing reviews, dietetics, physiotherapy, pharmacy, social work, addiction medicine, and neuropsychiatry, where indicated. A digital platform included remote weight monitoring and online surveys. The primary outcome was acceptability/feasibility. Secondary outcomes included safety, mortality, readmission, liver disease severity, and costs.
Fifty-nine patients were enrolled with median age 51 years (interquartile range (IQR): 45-59); majority alcohol etiology (74%),and median Model for End-Stage Liver Disease Sodium score 16 (IQR: 12-21). LivR Well was acceptable with low attrition (8 of 59), adherence to the program including home visits (mean 8.4 ± 4.2) and consultations (mean 2.4 ± 1.5) per patient. This was supported by positive feedback and themes identified through a qualitative subanalysis. Feasibility was demonstrated by recruitment rate of 4.94 patients/month and 86% completion. Mortality was lower than expected at 3%, 30-day readmission rate was 15%, and median Model for End-Stage Liver Disease Sodium score reduced to 15 ( = .01). Median 6-month costs reduced from $30,454 (IQR: $21,953-$65,657) to $17,657 ($4249-$42,876) ( = .009). The total 6-month health-care cost was $1,868,859 (95% confidence interval 1,081,821-2,655,897) compared to $2,518,227 (95% confidence interval 1,959,610-3,076,844).
LivR Well was acceptable, feasible, and safe with low short-term mortality and readmission rates. Health-care costs were reduced by 26% driven by a 40% reduction in 30-day readmission. Further evaluation includes a randomized controlled trial of LivR Well compared to standard care.
慢加急性肝衰竭（ACLF）的28天死亡率为22%-74%，30天再入院率为30%-40%。我们调查了针对ACLF的多模式社区干预措施的可接受性和可行性。
在一家三级医疗服务机构对连续入选的ACLF患者进行了单臂非随机试点研究。参与者接受每周一次的医疗和护理评估、饮食指导、物理治疗、药学、社会工作、成瘾医学以及必要时的神经精神病学服务。一个数字平台包括远程体重监测和在线调查。主要结局是可接受性/可行性。次要结局包括安全性、死亡率、再入院率、肝病严重程度和成本。
共纳入59例患者，中位年龄51岁（四分位间距（IQR）：45-59岁）；多数病因是酒精性（74%），终末期肝病钠模型评分中位数为16（IQR：12-21）。LivR Well项目是可接受的，脱落率低（59例中有8例），患者对该项目的依从性包括家访（平均8.4±4.2次）和会诊（平均2.4±1.5次）。定性子分析确定的积极反馈和主题支持了这一点。招募率为每月4.94例患者，完成率为86%，证明了该项目的可行性。死亡率低于预期，为3%，30天再入院率为15%，终末期肝病钠模型评分中位数降至15（P = 0.01）。6个月的成本中位数从30454美元（IQR：21953-65657美元）降至17657美元（4249-42876美元）（P = 0.009）。6个月的总医疗保健成本为1868859美元（95%置信区间1081821-2655897美元），而之前为2518227美元（95%置信区间1959610-3076844美元）。
LivR Well项目是可接受的、可行的且安全的，短期死亡率和再入院率较低。30天再入院率降低40%，推动医疗保健成本降低了26%。进一步评估包括将LivR Well项目与标准治疗进行随机对照试验。
