hospice guidelines for determining prognosis, liver disease

Guidelines: (not be a candidate for liver transplantation) 1) laboratory indicators of severely impaired liver function* a) prothrombin time > 5 seconds over control b) serum albumin < 2.5 gm/dl 2) clinical indicators of end-stage liver disease# a) ascites, refractory to sodium restriction & diuretics, or patient non compliant - spironolactone 75-150 mg/day + furosemide > 40 mg/day b) spontaneous bacterial peritonitis (SBP) 1] 30% 1 year survival 2] high mortality even when infection is cured if liver disease is severe or accompanied by renal disease c) hepatorenal syndrome d) hepatic encephalopathy, refactory to protein restriction & lactulose or neomycin, or patient non-compliant e) recurrent variceal bleeding 3) other factor portending a worse prognosis a) progressive malnutrition b) muscle wasting with reduced strength & endurance c) continued active alcoholism, i.e. > 80 g EtOH/day d) hepatocellular carcinoma e) HBsAg + * both a & b # any one of a-e

References

Medical Guidelines for Determining Prognosis in non-Cancer Diseases, 2nd edition, Stuart et al (eds), National Hospice Organization, Arlington, VA, 1996