Palliative care and end stage liver disease: A cohort analysis of palliative care use and factors associated with referral

Autores da FMUP

• Rui Manuel Lopes Nunes

  Autor

Participantes de fora da FMUP

• Oliveira H.M.
• Miranda H.P.
• Rego F.

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction and Objectives: Prevalence and mortality of chronic liver disease have risen significantly. In end stage liver disease, the survival of patients is approximately two years. Despite the poor prognosis and high symptom burden of these patients, integration of palliative care is limited. We aim to assess associated factors and trends in palliative care use in recent years. Materials and Methods: A Multicenter retrospective cohort of patients with end stage liver disease who suffered in-hospital mortality between 2017 and 2019. Information regarding patient demographics, hospital characteristics, comorbidities, etiology, decompensations, and interventions was collected. Two-sided tests and logistic regression analysis were used to identify factors associated with palliative care use. Results: A total of 201 patients were analyzed, with a yearly increase in palliative care consultation: 26.7 % in 2017 to 38.3 % in 2019. Patients in palliative care were older (65.72 ± 11.70 vs. 62.10 ± 11.44; p = 0.003), had a lower Karnofsky functionality scale (?=18.104; p = 0.000) and had higher rates of hepatic encephalopathy (32.1 % vs. 17.4 %, p = 0.007) and hepatocarcinoma (61.7 % vs. 26.2 %; p = 0.000). No differences were found for Model for End-stage Liver Disease (19.28 ± 6.60 vs. 19,90 ± 5.78; p = 0.507) or Child-Pugh scores (p = 0.739). None of the patients who die in the intensive care unit receive palliative care (0 % vs 31.6 %; p = 0.000). Half of the palliative care consultations occurred 6,5 days before death. Conclusions: Palliative care use differs based on demographics, disease complications, and severity. Despite its increasing implementation, palliative care intervention occurs late. Future investigations should identify approaches to achieve an earlier and concurrent care model. © 2024 Fundación Clínica Médica Sur, A.C.

Copyright © 2024 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.

Keywords

• Aged; End Stage Liver Disease; Female; Hospital Mortality; Humans; Liver Neoplasms; Male; Middle Aged; Palliative Care; Referral and Consultation; Retrospective Studies; adult; Article; Child Pugh score; clinical feature; cohort analysis; comorbidity; consultation; disease severity; end stage liver disease; female; hepatic encephalopathy; hospital mortality; human; intensive care unit; Karnofsky Performance Status; liver cell carcinoma; major clinical study; male; middle aged; Model For End Stage Liver Disease Score; palliative therapy; patient referral; retrospective study; risk factor; aged; clinical trial; diagnosis; epidemiology; liver tumor; mortality; multicenter study; therapy