Abstract
Context
Studies of palliative care (PC) in hospitalized patients with cirrhosis have been
retrospective, with limited evaluation of patient-reported measures and outcomes.
Objectives
To examine the relationship between PC, patient-reported measures (quality of life
and functional status), and outcomes.
Methods
We performed a prospective cohort study of patients with cirrhosis hospitalized from
2014 to 2019. We recorded PC consultation details, quality of life (chronic liver
disease questionnaire), and functional status (functional status questionnaire). Patients
were followed for 90 days to assess readmissions, costs, and mortality.
Results
Seventy-four of 679 patients saw PC, often later in the hospitalization (median hospital
day 8; IQR 4–16). Those who saw PC had greater Charlson comorbidity index (mean 6.8
vs. 5.9), MELD (mean 25 vs. 20), and prior 30-day admission (47% vs. 35%). Compared
to those who did not see PC, PC patients had greater impairments in intermediate activities
of daily living (83% vs. 72%), social activity (72% vs. 59%), quality of interactions
(49% vs. 36%), abdominal symptoms (mean score 3.1 vs. 3.6), activity (mean 3.3 vs.
3.6), and overall quality of life (mean 3.6 vs. 3.8). PC was associated with fewer
transfusions and upper endoscopies and with greater completion of advanced directives.
After multivariable adjustment, PC was not associated with intensive care, 30-day
readmissions, 90-day costs, or mortality.
Conclusion
PC occurs infrequently and late in those with more severe liver disease and functional
impairment. PC may be associated with reduction in utilization and greater completion
of advanced directives. Randomized trials are needed to evaluate PC for this population.
Key Words
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Article info
Publication history
Published online: February 20, 2022
Accepted:
February 15,
2022
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
