Excerpt

The guideline covers the identification and assessment of suspected cirrhosis, monitoring to detect complications and management of complications such as ascites and hepatorenal syndrome and referral for tertiary care.

Contents

• National Guideline Centre
• Acknowledgements
• 1. Guideline summary
  • 1.1. Algorithms
  • 1.2. Full list of recommendations
  • 1.3. Key research recommendations
• 2. Introduction
• 3. Development of the guideline
  • 3.1. What is a NICE clinical guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Identifying and analysing evidence of effectiveness
  • 4.4. Identifying and analysing evidence of cost-effectiveness
  • 4.5. Developing recommendations
• 5. Risk factors and risk assessment tools
  • 5.1. Introduction
  • 5.2. Review question 1: What are the risk factors that indicate the populations at specific risk for cirrhosis?
  • 5.3. Review question 2: Are there any validated risk tools that indicate the populations at specific risk for cirrhosis?
  • 5.4. Clinical evidence
  • 5.5. Economic evidence
  • 5.6. Evidence statements
  • 5.7. Recommendations and link to evidence
• 6. Diagnostic tests
  • 6.1. Introduction
  • 6.2. Review question: In people with suspected (or under investigation for) cirrhosis
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Severity risk tools
  • 7.1. Introduction
  • 7.2. Review question 1: Which risk assessment tool is the most accurate and cost-effective for predicting the risk of morbidity and mortality in people with compensated cirrhosis? Review question 2: When (at what severity score on the risk assessment tool) should people with cirrhosis be referred to specialist care?
  • 7.3. Clinical evidence
  • 7.4. Economic evidence
  • 7.5. Evidence statements
  • 7.6. Recommendations and link to evidence
• 8. Surveillance for the early detection of hepatocellular carcinoma (HCC)
  • 8.1. Introduction
  • 8.2. Review question: When and how frequently should surveillance testing be offered for the early detection of hepatocellular carcinoma (HCC) in people with cirrhosis?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6. Recommendations and link to evidence
• 9. Surveillance for the detection of varices
  • 9.1. Introduction
  • 9.2. Review question: How frequently should surveillance testing using endoscopy be offered for the detection of oesophageal varices and isolated gastric varices in people with cirrhosis?
  • 9.3. Clinical evidence
  • 9.4. Economic evidence
  • 9.5. Evidence statements
  • 9.6. Recommendations and link to evidence
• 10. Prophylaxis of variceal haemorrhage
  • 10.1. Introduction
  • 10.2. Review question 1: What is the clinical and cost-effectiveness of non-selective beta-blockers for the primary prevention of bleeding in people with oesophageal varices due to cirrhosis? Review question 2: What is the clinical and cost-effectiveness of endoscopic band ligation for the primary prevention of bleeding in people with oesophageal varices due to cirrhosis? Review question 3: What is the clinical and cost-effectiveness of non-selective beta-blockers compared with endoscopic band ligation for the primary prevention of bleeding in people with oesophageal varices due to cirrhosis?
  • 10.3. Clinical evidence
  • 10.4. Economic evidence
  • 10.5. Evidence statements
  • 10.6. Recommendations and link to evidence
• 11. Primary prevention of bacterial infections in cirrhosis and upper gastrointestinal bleeding
  • 11.1. Introduction
  • 11.2. Review question: What is the most clinical and cost-effective prophylactic antibiotic for the primary prevention of bacterial infections in people with cirrhosis and upper gastrointestinal bleeding?
  • 11.3. Clinical evidence
  • 11.4. Economic evidence
  • 11.5. Evidence statements
  • 11.6. Recommendations and link to evidence
• 12. Transjugular intrahepatic portosystemic shunt (TIPS) versus large-volume paracentesis (LVP) for ascites
  • 12.1. Introduction
  • 12.2. Review question: What is the clinical and cost-effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) compared with large-volume paracentesis (LVP) with albumin in the management of diuretic-resistant ascites due to cirrhosis?
  • 12.3. Clinical evidence
  • 12.4. Economic evidence
  • 12.5. Evidence statements
  • 12.6. Recommendations and link to evidence
• 13. Primary prevention of spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites
  • 13.1. Introduction
  • 13.2. Review question: What is the clinical and cost-effectiveness of antibiotics compared with placebo for the primary prevention of spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites?
  • 13.3. Clinical evidence
  • 13.4. Economic evidence
  • 13.5. Evidence statements
  • 13.6. Recommendations and link to evidence
• 14. Volume replacers in hepatorenal syndrome
  • 14.1. Introduction
  • 14.2. Review question: Which is the most clinical and cost-effective volume replacer for patients with hepatorenal syndrome due to cirrhosis who are also receiving vasoactive drugs?
  • 14.3. Clinical evidence
  • 14.4. Economic evidence
  • 14.5. Evidence statements
  • 14.6. Recommendations and link to evidence
• 15. Management of an episode of acute hepatic encephalopathy
  • 15.1. Introduction
  • 15.2. Review question: What is the most clinically and cost-effective intervention for the first-line treatment of an episode of acute hepatic encephalopathy in people with cirrhosis?
  • 15.3. Clinical evidence
  • 15.4. Economic evidence
  • 15.5. Evidence statements
  • 15.6. Recommendations and link to evidence
• 16. Reference list
• 17. Acronyms and abbreviations
• 18. Glossary
• Appendices A–H
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Clinical review protocols
  • Appendix D. Health economic review protocol
  • Appendix E. Clinical article selection
  • Appendix F. Health economic article selection
  • Appendix G. Literature search strategies
  • Appendix H. Clinical evidence tables
  • References
• Appendices I–Q
  • Appendix I. Economic evidence tables
  • Appendix J. GRADE tables
  • Appendix K. Forest plots
  • Appendix L. Excluded clinical studies
  • Appendix M. Excluded health economic studies
  • Appendix N. Cost-effectiveness analysis: diagnostic tests and surveillance strategies for cirrhosis
  • Appendix O. Unit costs
  • Appendix P. Research recommendations
  • Appendix Q. NICE technical team
  • References

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer.