Comparing nurse-assisted outpatient follow-up with standard care among patients with decompensated liver cirrhosis: a systematic review and meta-analysis

Nurse-assisted care has been shown to improve outcomes in these patients when compared with standard care. This study aimed to compare nurse-assisted outpatient follow-up with standard care in patients with decompensated liver failure. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) comparing specialized or nurse-assisted care with standard care in patients with decompensated liver cirrhosis. Outcomes of interest were mortality, 30-day readmission, model for end-stage liver disease (MELD) score, Child-Pugh score, and mean number of hospital stays. Evaluations were reported as risk ratios and mean differences, with 95% confidence intervals (CIs) using weighted random-effects models. The analysis included 668 patients from seven studies (three RCTs and four observational studies). Compared with standard care, nursing and multidisciplinary care showed no significant reduction in mortality (risk ratio: 0.78, 95% CI: 0.53-1.16, P = 0.12, I ² = 69%); however, upon subgroup analysis according to type of study significant reduction was noted among RCTs [risk ratio: 0.53, 95% CI: 0.30-0.94, P = 0.03, I ² = 0%). Meta-analysis also showed a significant reduction in 30-day readmission rates (risk ratio: 0.39, 95% CI: 0.25-0.59, P < 0.0001, I ²=0%), which were consistent upon subgroup analysis. There was no significant difference in Child-Pugh score (mean difference: 0.07, 95% CI: -0.79 to 0.93, P = 0.83, I ² = 0%), MELD score (mean difference: 0.17, 95% CI: -1.33 to 1.67, P = 0.82, I ² = 0%) and mean difference in number of hospital stay (mean difference: -1.59, 95% CI: -5.68 to 2.51, P = 0.45, I ² = 89%). Results were consistent upon subgroup analysis except for the mean number of hospital stays, which showed a significant reduction among observational studies (mean difference: -4.20, 95% CI: -8.18 to -0.22, P = 0.04).