A randomized controlled trial of a postdischarge nursing intervention for patients with decompensated cirrhosis

Abstract
Background: Few randomized trials have evaluated the effect of postdischarge
interventions for patients with liver cirrhosis. This study assessed
the effects of a postdischarge intervention on readmissions and mortality in
patients with decompensated liver cirrhosis.
Methods: We conducted a randomized controlled trial at a specialized liver
unit. Adult patients admitted with complications of liver cirrhosis were eligible
for inclusion. Participants were allocated 1:1 to standard follow-up or a
family-focused nurse-led postdischarge intervention between December 1,
2019, and October 31, 2021. The 6-month intervention consisted of a patient
pamphlet, 3 home visits, and 3 follow-up telephone calls by a specialized
liver nurse. The primary outcome was the number of readmissions due to
liver cirrhosis.
Results: Of the 110 included participants, 93% had alcohol as a primary etiology.
We found no significant differences in effects in the primary outcomes
such as time to first readmission, number of patients readmitted, and duration of
readmissions or in the secondary outcomes like health-related quality of life and
6- and 12-month mortality. A post hoc exploratory analysis showed a significant
reduction in nonattendance rates in the intervention group (RR: 0.28, 95% CI:
0.13–0.54, p=0.0004) and significantly fewer participants continuing to consume
alcohol in the intervention group (p=0.003). After 12 months, the total
number of readmissions (RR: 0.76, 95% CI: 0.59–0.96, p=0.02) and liverrelated
readmissions (RR: 0.55, 95% CI: 0.36–0.82, p=0.003) were reduced in
the intervention group.
Conclusions: A family-focused postdischarge nursing intervention had no
significant effects on any of the primary or secondary outcomes. In a post hoc
exploratory analysis, we found reduced 6-month nonattendance and alcohol