Patients are considered to be in the terminal stages of liver disease if they meet the following criteria. Their effects are cumulative and prognosis worsens with the addition of each factor.
1. Prothrombin time > 5 sec over control, or
- INR > 1.5
&and serum albumin < 2.5 gm/dl
2. Patient has at least one of the following:
- Ascites, refractory to treatment or patient non-compliant
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome - elevated BUN and creatinine with oliguria (<400 ml/day) and urine Na+ < 10mEq/l
- Hepatic encephalopathy, refractory to treatment or patient non-compliant
- Recurrent variceal bleeding, despite intensive therapy
Factors that may worsen prognosis and if documented, support hospice eligibility:
- Progressive malnutrition
- Muscle wasting with reduced strength / endurance
- Continued active alcoholism (> 80 Gm Ethanol per day)
- Hepatocellular carcinoma
- Hbs
Ag (Hepatitis B) positivity - Hepatitis C, refractory to interferon treatment
If patient is awaiting transplant but otherwise fits the above criteria, they may be certified for the hospice benefit. If an organ is procured, the patient must be discharged from hospice.
**If your patient does not meet the above criteria, they may still qualify for hospice services. Contact the Hospice Care of Kansas location nearest you for assistance in assessing your patient for appropriateness.
