Evidence on the impact of treatment optimization on the safety of patients with liver cirrhosis.
Andrea Rodríguez Esquíroz, Javier Garjón Parra, Amaya Echeverría Gorriti et al.
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In 30 seconds
This systematic review assessed whether optimizing medication therapy improves medication-related safety in people with liver cirrhosis. Six articles were identified, all reporting a single randomized controlled trial of 116 patients comparing pharmacist-led medication reconciliation and individualized education with usual care. The review found no significant differences in all-cause mortality or crude relative risk of hospitalization. However, adjusted incidence-rate analysis showed a 48% reduction in unplanned hospitalizations with the intervention. Within the intervention group, higher rates of high-risk medication-related problems were associated with substantially higher odds of mortality, independently of disease severity.
Key findings
- The pharmacist-led intervention reduced unplanned hospitalizations by 48% in adjusted incidence-rate analysis.
- No significant differences were found in all-cause mortality or crude relative risk of hospitalization.
- Within the intervention group, each unit increase in high-risk medication-related problems was associated with more than three-fold higher odds of mortality, independently of disease severity.
Why it matters
Medication-related problems may contribute to preventable hospital use and are associated with mortality risk in cirrhosis. The review highlights medication safety as a potentially important component of care, while also showing that the evidence base is narrow and that the hospitalization finding depends on adjusted analysis rather than the crude comparison.
What to keep in mind
The review identified only one randomized trial, reported across six articles, limiting the evidence base. The intervention’s hospitalization benefit was evident in adjusted incidence-rate analysis, but not in the crude relative risk comparison.