Table 2.
The Cirrhosis Quality Indicator Subset
| Domain | Quality Indicators | Evidence |
|---|---|---|
| Ascites | If hospitalized patients with ascites have an ascitic fluid polymorphonuclear count of ≥ 250 cells/mm3, they should receive empiric antibiotics within 6 hours of the test result for hospitalized patients and within 24 hours for ambulatory patients. |
Grade 1 Class 1, Level A |
| Ascites | If patients have clinically apparent (i.e., moderate to severe) ascites and normal renal function, they should be managed with both salt restriction and diuretics (including a combination of spirolonactone and loop diuretics). |
Grade I Class I, Level A |
| Ascites | If patients with ascites are admitted to the hospital for evaluation and management of symptoms related to ascites or encephalopathy, they should receive a diagnostic paracentesis during the index hospitalization. |
Grade II‐3 Class I, Level C |
| Variceal bleeding | If patients have cirrhosis, no documented history of previous GI bleeding, and have medium/large varices on endoscopy, they should receive either nonselective beta‐blockers or EVL within 1 month of varices diagnosis. |
Grade I Class I, Level A |
| Variceal bleeding | If patients with cirrhosis present with upper GI bleeding, they should receive upper endoscopy within 24 hours of presentation. |
Grade I Class I, Level A |
| Variceal bleeding | If patients with cirrhosis are admitted with or develop suspected variceal bleeding, they should receive somatostatin or analogues (somatostatin, octreotide, terlipressin) within 12 hours of presentation. |
Grade I Class IIA, Level A |
| Variceal bleeding | If patients with cirrhosis survive an episode of acute variceal hemorrhage, they should receive one of the following therapies to prevent recurrence of variceal hemorrhage: EVL every 1‐2 weeks until obliteration, beta‐blockers, or a combination or EVL and beta‐blockers. |
Grade I Class I, Level A |
| Variceal bleeding | If patients with cirrhosis are found to have bleeding esophageal varices, they should receive EVL or sclerotherapy at the time of index endoscopy. |
Grade I Class I, Level A |
| Liver cancer | If patients have cirrhosis, they should receive surveillance for hepatocellular cancer using imaging with or without alpha fetoprotein every 6‐12 months. |
Grade I, Class IIa, Level A |
Cirrhosis quality indicators that were endorsed as important based on the magnitude of health or health‐related quality of life benefit derived from performing the indicated processes. The last column presents the evidence that supported each indicator.
Abbreviations: EVL, endoscopic variceal ligation; GI, gastrointestinal.