Effect of multidisciplinary team care on the management of cirrhotic patients with upper gastrointestinal bleeding: a retrospective cohort study.

Abstract

BACKGROUND\nMultidisciplinary team care (MDTC) has been proposed to improve the prognosis and quality of life of patients through the collaboration of multiple disciplines. However, it is still unclear whether MDTC is effective in the management of cirrhotic patients with upper gastrointestinal bleeding (UGIB).\n\n\nMETHODS\nThis was a retrospective cohort study enrolling cirrhotic patients with UGIB receiving traditional care or MDTC between July 2015 and December 2019. Clinical data and laboratory test results of enrolled patients were collected by 2 independent investigators. The primary outcomes were mortality and the incidence of rebleeding within 1 year. Furthermore, the quality of life of enrolled patients was chosen as the secondary outcome. Multivariable logistic regression was used to determine the risk factors of mortality and rebleeding, after adjusting for confounding variables by univariable logistic regression. Also, multivariable linear regression was used to determine the effects of MDTC on the quality of life of enrolled patients.\n\n\nRESULTS\nThis study finally included 206 cirrhotic patients with UGIB, with 101 patients in the traditional care group and 105 patients in the MDTC group. Compared with the traditional care group, patients in the MDTC group had significantly higher Child-Pugh and model for end-stage liver disease (MELD) scores (P=0.02 and 0.04, respectively). Furthermore, patients in the MDTC group had a significantly lower level of white blood cells (WBC) and a significantly higher level of aspartate transaminase (AST) compared to the traditional care group (P=0.01 and 0.02, respectively). Multivariable logistic regression then identified MDTC as a protective factor for rebleeding and mortality within 1 year. Higher MELD scores and more required units of packed red blood cells (RBC) were associated with a higher incidence of rebleeding and mortality. Additionally, patients in the MDTC group had less discomfort and depression than those in the traditional care group (both P<0.01), and MDTC was associated with improved quality of life according to the multivariable linear regression analysis.\n\n\nCONCLUSIONS\nMDTC, compared with traditional care, reduced the incidence of rebleeding and mortality over the long term. It was also useful for relieving anxiety and improving the quality of life of patients.