Palliative care beneficial for patients with end-stage liver disease
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CHARLOTTE, N.C. — Early palliative care referral would benefit patients with end-stage liver disease, resulting in fewer hospitalizations and more health care proxy assignments and code status changes, according to a presenter here.
“Patients with end-stage liver disease who are not liver transplant candidates often have a trajectory of rapid declining health and death just like patients with stage IV cancer,” Le Yu Naing, MD, an internal medicine resident at Rochester General Hospital at the time of the study and now a post-doctoral fellow at the University of Louisville, said during her presentation at the ACG Annual Scientific Meeting. “Mortality rates from compensated liver disease range from 1% to 3% per year, but mortality rate increases in the case of decompensated liver disease.”
Naing and colleagues conducted a retrospective analysis to determine the utilization and benefits of palliative care services among adult patients with ESLD admitted to Rochester Regional Health system hospitals from 2012 to 2021. The researchers further sought to establish a standard of care in these patients.
Of 576 patients, palliative care was involved in 237 (41.1%) and was not involved in 339 (58.9%). Baseline characteristics were comparable between the two groups.
According to the presentation, a greater proportion of patients with vs. without palliative care consults had health care proxy assigned (63.7% vs. 37.5%; P < .001), Aspira catheter use (5.9% vs. 0.9%; P < .001), hospitalizations for frequent paracentesis (30.8% vs. 16.8%; P < .001) and changes in code status (77.6% vs. 29.2%; P < .001). Also, 59.9% of patients with palliative care consults had do not resuscitate comfort care code status, whereas 67.8% of those without consults had full code status. Before palliative care consult, the mean number of hospital admissions was 15.66; this number dropped to 3.49 after consult.
Results also showed that the mortality rate in those patients with palliative care was significantly higher than in those without (83.1% vs. 46.4%; P < .01).
The research showed that palliative care consults are beneficial for patients with advanced liver diseases, Naing said.
“Mortality rates are higher with palliative care involvement,” Naing said. “However, the mortality without palliative care involvement was also high.”
The difference in mortality rates, the researchers wrote in their abstract, suggests that patients received a palliative care referral when their disease severity was significant. All patients, however, would benefit from early palliative care, the researchers continued.
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Naing LY, et al. Early palliative care referral may improve end of life care in end-stage liver disease patients. A retrospective analysis from a non-transplant center. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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