Effect of Multidisciplinary Team-Based Refined Nursing on Outcomes in Elderly Patients with Liver Cirrhosis and Upper Gastrointestinal Bleeding

Summary

Multidisciplinary team-based refined nursing enhanced short-term results and quality of life in elderly liver cirrhosis patients with upper gastrointestinal bleeding, but had no impact on long-term survival or comorbidities.

Abstract

The purpose of this study is to investigate how a multidisciplinary team (MDT)-based refined nursing approach enhances clinical outcomes (including hemostatic efficacy, nutritional improvement, psychological well-being, rebleeding rates, and life quality) in elderly liver cirrhosis (LC) patients complicated with upper gastrointestinal bleeding (UGIB). Using a prospective randomized controlled trial design, 120 elderly LC + UGIB patients (2023-2024) were randomized to receive either routine care (control group, n = 60) or MDT-based refined nursing (intervention group, n = 60). MDT-refined nursing includes 3-phase interventions: acute phase (24-72 h) with half-hourly vital sign monitoring and enteral nutrition initiation within 6 h of hemostasis; recovery phase (3-7 days) incorporating pharmacist-led medication reconciliation and biweekly psychotherapy; and 1-year follow-up with telemedicine support. The main outcome measures were hemostasis time, blood transfusion volume, blood pressure control, self-care ability, nutritional status, psychological well-being, short-term adverse events, 1-year rebleeding incidence, and quality of life. The results of the study showed that the intervention group showed better outcomes in hemostasis, nutrition, psychological status, and quality of life, but survival was unaffected. However, quality-of-life measures favored the intervention group. In conclusion, MDT-based refined nursing optimizes hemostasis efficiency, nutrition, and mental health in elderly LC patients with UGIB while lowering rebleeding risk and enhancing life quality.

Introduction

Liver cirrhosis (LC), a prevalent chronic progressive digestive disorder with a rising global incidence, particularly affects individuals aged over 60 years who constitute nearly 40% of cases^1,2. Upper gastrointestinal bleeding (UGIB) is one of the most serious complications of LC, with an annual incidence of 30%-50%^3,4. Elderly LC patients face heightened risks due to frequent comorbidities such as multiorgan dysfunction, reduced vascular elasticity, and impaired coagulation. Consequently, their mortality rate during initial bleeding episodes reaches ....

Protocol

Ethical approval was granted by the Bioethics Committee of Beijing Friendship Hospital Affiliated to Capital Medical University (Approval number: 2024-P2-424-02), and all participants provided written informed consent. The reagents and the equipment used are listed in the Table of Materials.

1. Selection of research subjects

The research was carried out as a prospective randomized controlled trial in our hospital's Gastroenterology and Geriatrics Department between January 2023 and February 2024. The study focused on elderly LC patients suffering from UGIB.

Results

Comparison of patient rehabilitation
The two groups did not differ significantly in hospitalization time (P>0.05); However, the intervention group showed shorter hemostasis time and lower transfusion volumes (P<0.05). In terms of blood pressure control, both groups achieved significant SBP and DBP reductions post-intervention, with greater decreases in the intervention group (P<0.05, Table 2).

Comparison of self-care ability
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Discussion

In this study, a prospective randomized controlled trial was conducted to explore the effect of MDT-based refined nursing on the prognosis of elderly LC patients complicated with UGIB. The results showed superior outcomes in the intervention group, evidenced by faster hemostasis, fewer blood transfusions, better blood pressure control, greater improvements in self-care ability, nutritional status, and psychological well-being, and a lower rebleeding rate, despite comparable hospitalization time, short-term complications,.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automatic biochemical analyzer	Mindray	BS-1000M	determine the levels of nutritional parameters
Lactulose solution	Fengchen Group Co., Ltd.	H10890057	treat constipation by increasing water content in the colon.
Short-chain peptide enteral feeds	Fengchen Group Co., Ltd.	H20170170	Nutritional support