Prognosis of Liver Disease Based On Hospice Admission Criteria

What follows is the prognosis for liver disease based on hospice admission criteria. If a patient meets these criteria he or she is eligible for hospice care which means that they have six months or less to live.

To meet the CMS Disease Specific Criteria For Terminal (less than 6 months) liver disease, the patient must meet:

A patient is eligible for hospice services if he
meets these three criteria:
1) has a Palliative Performance Scale of less than 70%
2) is dependent on at least two Activities of Daily Living, and
3) meets the Disease Specific Guideline [for liver disease] below:

Liver Disease
Patients will be considered to be in the terminal stage of
liver disease (life expectancy of six months or less) if they
meet the following criteria. (1 and 2 should be present,
factors from 3 will lend supporting documentation.)
1. The patient should show both a and b:
a. Prothrombin time prolonged more than 5 seconds over
control, or International Normalized Ratio (INR) >1.5;
b. Serum albumin <2.5 gm/dl.
2. End stage liver disease is present and the patient shows
at least one of the following:
a. Ascites, refractory to treatment or patient noncompliant; b. Spontaneous bacterial peritonitis;
c. Hepatorenal syndrome (elevated creatinine and
BUN with oliguria (<400 ml/day) and urine sodium
concentration <10 mEq/l);
d. Hepatic encephalopathy, refractory to treatment, or
patient non-compliant;
e. Recurrent variceal bleeding, despite intensive therapy.
3. Documentation of the following factors will support
eligibility for hospice care:
a. Progressive malnutrition;
b. Muscle wasting with reduced strength and endurance;
c. Continued active alcoholism (>80 gm ethanol/day);
d. Hepatocellular carcinoma;
e. HBsAg (Hepatitis B) positivity;
f. Hepatitis C refractory to interferon treatment