Evaluating Clinician Adherence to American Association for the Study of Liver Diseases Guidelines for Ascites

Abstract

In 2017 there were 41,743 cirrhosis-related deaths in the U.S. Between 2006 and 2011 there were approximately 3,127,986 cirrhosis-related Emergency Department (ED) visits nationwide. In addition, cirrhosis-related mortality increased by 65% between 1999 and 2016 due to a rise in alcohol use disorder and alcohol-related liver disease. A common complication of cirrhosis is ascites, which subsequently increases the risk for infections, most commonly spontaneous bacterial peritonitis (SBP). SBP is caused by an enteric bacteria which infects mesenteric lymph nodes and ascitic fluid. In 2012, the American Association for the Study of Liver Diseases (AASLD) produced a practice guideline for medical professionals providing care to patients with clinically detectable ascites. The guideline includes 49 recommendations, based on published literature, which intend to improve care provided to cirrhotic patients with ascites. In this study, we aim to evaluate clinician adherence to 4 main AASLD guidelines in acute management of ED patients with ascites.