hospice guidelines for determining prognosis, liver disease

Introduction

Guidelines: (not be a candidate for liver transplantation)

• laboratory indicators of severely impaired liver function*
  • prothrombin time > 5 seconds over control
  • serum albumin < 2.5 gm/dl
• clinical indicators of end-stage liver disease#
  • ascites, refractory to sodium restriction & diuretics, or patient non compliant
    • spironolactone 75-150 mg/day + furosemide > 40 mg/day
  • spontaneous bacterial peritonitis (SBP)
    • 30% 1 year survival
    • high mortality even when infection is cured if liver disease is severe or accompanied by renal disease
  • hepatorenal syndrome
  • hepatic encephalopathy, refactory to protein restriction & lactulose or neomycin, or patient non-compliant
  • recurrent variceal bleeding
• other factor portending a worse prognosis
  • progressive malnutrition
  • muscle wasting with reduced strength & endurance
  • continued active alcoholism, i.e. > 80 g EtOH/day
  • hepatocellular carcinoma
  • HBsAg +

* both a & b

# any one of a-e

More general terms

• hospice guidelines for determining prognosis