Decompensated Cirrhosis Care Bundle - First 24 Hours

Publication: 29/05/2020  --
Last review: 01/01/1900  
Next review: 29/05/2023  
Clinical Guideline
ID: 6451 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Decompensated Cirrhosis Care Bundle - First 24 Hours

This bundle was developed by the British Society of Gastroenterology and British Association for Liver Disease in response to evidence that the care some patients admitted with decompensated cirrhosis in the UK was suboptimal. Admission with decompensated cirrhosis is a common medical presentation and carries a high mortality (10-20% in hospital mortality). Early intervention with evidence-based treatments for patients with the complications of cirrhosis can save lives.

Decompensated cirrhosis is defined as a patient with cirrhosis who presents with an acute deterioration in liver function that can manifest with the following symptoms:

  • Jaundice
  • Increasing ascites
  • Hepatic encephalopathy
  • Renal impairment
  • GI bleeding
  • Signs of sepsis/hypovolaemia

When assessing patients who present with decompensated cirrhosis please look for the precipitating causes and treat accordingly. Common causes are: 

  • GI bleeding (variceal and non-variceal)
  • Infection/sepsis (spontaneous bacterial peritonitis, urine, chest, cholangitis etc)
  • Alcoholic hepatitis
  • Acute portal vein thrombosis
  • Development of hepatocellular carcinoma
  • Drugs (Alcohol, opiates, NSAIDs etc)
  • Ischaemic liver injury (sepsis or hypotension)
  • Dehydration
  • Constipation

The checklist shown below gives a guide on the necessary investigations and early management of these patients admitted with decompensated cirrhosis and should be completed on all patients who present with this condition.  The checklist is designed to optimize a patient’s management in the first 24 hours when specialist liver/gastro input might not be available.

Please arrange for a review of the patient by the gastro/liver team at the earliest opportunity. In LTHT, please contact the gastroenterology team (on call doctor at bleep 4770) or if the patient is currently on the liver transplant waiting list, or received a large volume paracentesis on the refractory ascites pathway on the J83 day ward, please contact the hepatology on call doctor at bleep 4873.

Escalation of care to higher level should be considered in patients not responding to treatment when reviewed after 6 hours, particularly in those with first presentation and those with good underlying performance status prior to the recent illness.

In LTHT, please refer to the following guidelines on Leeds Health Pathways:

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Record: 6451
Clinical condition:

Decompensated cirrhosis

Target patient group:
Target professional group(s): Secondary Care Doctors
Adapted from:

Evidence base

Not supplied

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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