[Translated article] Evidence on the impact of treatment optimization on the safety of patients with liver cirrhosis.

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 involving 116 patients. The trial compared pharmacist-led medication reconciliation and individualized health education with usual care. It found no significant differences in all-cause mortality or crude relative risk of hospitalization, but adjusted incidence-rate analysis showed a 48% reduction in unplanned hospitalizations with the intervention. The review also reported an association between high-risk medication-related problems and mortality within the intervention group.

Key findings

• The review identified six articles, all from one randomized controlled trial involving 116 patients.
• Adjusted incidence-rate analysis found pharmacist-led follow-up reduced unplanned hospitalizations by 48%.
• 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 adverse outcomes in cirrhosis. The findings suggest that structured medication review and patient education could improve safety, while the association between high-risk problems and mortality underscores the clinical importance of identifying them. However, the evidence base is very limited, so the apparent benefit should be interpreted cautiously.

What to keep in mind

The review found only one randomized trial, reported across six articles, leaving a limited evidence base. The trial found no significant differences in mortality or crude hospitalization risk.