The Cirrhosis Outpatient Optimization, Readmission & Safety Study

COORS: The Cirrhosis Outpatient Optimization, Readmission & Safety Study

A prospective series comparing care incorporating home monitoring and liver care coordination to conventional care for patients with cirrhosis.

Telemonitoring has been suggested to have potential benefits in patients with cirrhosis. However, to date, no prospective studies exist to support this idea. Hence, the investigators study would like to explore the use of home telemonitoring devices with vital sign capturing capabilities in recently-discharged patients with cirrhosis to decrease 30-day readmissions, mortality and costs.

This is prospective, randomized controlled trial comparing two strategies of post-discharged care in patients with cirrhosis-related hospitalizations.

First treatment arm will incorporate the Vivify home monitoring device into post hospital care.Home monitoring kits include a tablet with wireless internet and vital sign monitoring capabilities (temperature, blood pressure, heart rate, weight and pulse oximetry if needed) and the device has the ability to trigger an alert to the "liver care coordinator."

Second treatment arm will continue the standard of care therapy that all post- hospitalized patients receive upon discharge, i.e. return to clinic appointments, education regarding any signs or worsening symptoms to watch for, as well as contact numbers to connect with their doctor or nurse.

Inclusion Criteria:

1. Ascites requiring paracentesis during the hospitalization
2. Hepatic encephalopathy defined as altered mental status that improves after treatment with lactulose
3. Variceal hemorrhage, defined as clinically significant gastrointestinal bleed (tachycardia, hypotension, requirement for blood transfusion, or >2g drop in hemoglobin) and varices seen on endoscopy
4. Spontaneous bacterial peritonitis defined as >250 polymorphonuclear cells per high-power field and/or monomicrobial culture in the ascetic fluid
5. Renal failure in the presence of ascites, defined as a rise in the serum creatinine by 0.5mg/dl (to >1.5mg/dl), with ascites documented on physical exam or ultrasound, or admitted on diuretics for the treatment of ascites
6. Hyponatremia, defined by serum sodium <130 on admission labs
7. Hepatocellular carcinoma as seen on arterial phase MRI or liver biopsy, if tumor is treated and fits within Milan criteria

Exclusion Criteria:

• Admissions for scheduled or elective procedures

• Patients with a comorbid conditions with a life expectancy of less than 12 months or ones that may confound a patient's clinical course

  • Hepatocellular carcinoma
  • Hepatorenal syndrome
  • Hepatopulmonary syndrome
  • Metastatic cancer
  • Chronic kidney disease (pre-dialysis, dialysis)
  • Congestive heart failure
  • Diagnosed dementia
  • HIV/AIDS
  • Pregnancy or planned pregnancy during the study
  • Those managed by palliative care
  • Patients with liver transplants prior to or during the index hospitalization
  • Patients unable to understand study procedures/instructions/use of the home monitoring device
  • Patients unable to stand for <1 minute
  • Patients living in nursing homes or similar institutions