Medicine (Austin & Northern Health) - Theses

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Clinical risk stratification in patients with advanced liver disease and portal hypertension

Robertson, Marcus Christian ( 2021)

Liver cirrhosis, an advanced stage of progressive hepatic fibrosis resulting from any chronic insult to the liver, is a serious medical condition that adversely affects both quality of life and life expectancy. Risk stratification represents a systematic predictive modelling process to identify patients who are at risk of poorer health outcomes and who are expected to benefit most from a particular intervention. Risk stratification in liver disease was first developed in the 1960's and has experienced a resurgence of interest with the development of new therapies for cirrhosis and the increasing accessibility of liver transplantation. The aim of this thesis is to advance the knowledge of risk stratification in patients with cirrhosis to guide clinical decision making and ultimately improve patient care. In the lifecycle of a typical patient with cirrhosis, clinical settings were identified where a paucity of literature currently exists in relation to risk stratification. These include acute variceal bleeding, the development of hepatic encephalopathy, pre-transplantation stratification of cardiac risk and post-transplantation clinical deterioration and unplanned intensive care unit readmission.