Attributes and outcomes of end stage liver disease as compared with other noncancer patients admitted to a geriatric palliative care unit

Abstract

Patients with ESLD were younger and had a higher PPS score with no significant difference in estimated prognosis, LOS, or disposition when compared to other noncancer patients. Our findings suggest that patients with ESLD have a short LOS on the PCU with a unique illness experience compared to other noncancer patients.

Identifying palliative care needs in a Portuguese liver unit

“…4 Coincidently, our study also demonstrates that the majority of the hospitalised patients in our unit were in late stages of liver disease (55% were in Child-Pugh C stage, and 48.3% had a MELD score higher than 15) and only 6. year period of follow-up and found that patients were significantly younger (P < .001) and were admitted with significantly higher palliative performance scores (P < .001) than patients with other noncancerous diagnoses, with no significant differences in estimated prognosis and length of hospital stay. 21 As it would be expected, the NECPAL cannot be a tool to limit life measures or access prognosis, as in multivariate regression analysis it was not a predictor of ICU admission or mortality, unlike other scores such as MELD, which are validated for this purpose. 27 Gómez-Batiste et al found that the NECPAL tool had high sensitivity (91.3, CI: 87.2-94.2) with high negative predictive value (91.0, CI: 86.9-94.0) but a very low specificity (32.9, CI: 29.6-36.3) and low positive predictive value (33.5, CI: 30.2-36.9), in predicting 12-month mortality.…”

“…Furthermore, because of the clear lack of a “terminal phase” in ESLD, concerns have been raised that palliative care is often initiated only when death is perceived as being imminent and that ESLD patients may be admitted late in their disease course, not allowing for equitable access to such a service because of a perceived longer length of stay in palliative care units . Perri et al evaluated 235 patients admitted to a palliative care unit during a 5‐year period of follow‐up and found that patients were significantly younger ( P < .001) and were admitted with significantly higher palliative performance scores ( P < .001) than patients with other noncancerous diagnoses, with no significant differences in estimated prognosis and length of hospital stay . Moreover, Baumann et al demonstrated that the implementation of early palliative care intervention improved symptoms burden and mood in end‐stage liver disease patients awaiting a liver transplant .…”

Palliative care access for hospitalized patients with end‐stage liver disease across the United States

“…Quality of life can be negatively impacted by such physical symptoms, as well as the psychological complications of the illness for the patient and family. There is increasing awareness of the benefit of palliative care (PC) services for these patients in terms of symptom management and palliation . Unfortunately, data are limited regarding access to PC in patients with ESLD.…”

“…There is increasing awareness of the benefit of palliative care (PC) services for these patients in terms of symptom management and palliation. (5)(6)(7)(8) Unfortunately, data are limited regarding access to PC in patients with ESLD. Poonja et al demonstrated that a lack of PC support network/service negatively impacted upon quality of life in a cohort of nontransplant candidates with ESLD; however, this was a single-center retrospective study with a small patient cohort.…”

Palliative Care in End-Stage Liver Disease Patients Awaiting Liver Transplantation: Review

“…It is responsible for almost 2% of all deaths and is currently the 7th leading cause of death at the European level [2]. ESLD is the leading cause of organ failure amongst the population under 65 years [3], thus corresponding to a very significant loss of years of potential life. Episodes of decompensation have a significant impact on mortality, and it is estimated that, after the first episode, mortality at 5 years may reach 85% [4].…”