The causes of liver disease are many and varied. Leading causes are viral infection, alcohol abuse, and inherited disease. A common symptom of liver disease is jaundice. With jaundice, the skin and the whites of the eyes take on a yellowish color as a result of the accumulation of bilirubin and bile pigments in the blood. This is a sign that the liver or the biliary system is not functioning properly. Other symptoms of liver disease include an enlarged liver and swollen abdomen, nausea, vomiting, weight loss, and fatigue. Some infections cause flu-like symptoms of fever, headache, and weakness.
Patients will be considered to be in the terminal stage of liver disease if they meet the following criteria: 1 and 2 MUST be present; factors from 3 will lend supporting documentation.
1. The patient has end stage liver disease as evidenced by BOTH of the following:
- Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR)>1.5
- Serum albumin
2. The patient shows at least ONE of the following:
- Ascites, refractory to treatment or patient non-compliant
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome (elevated creatinine and BUN with oliguria (<400ml/day) and urine sodium concentration
- Hepatic encephalopathy, refractory to treatment, or patient non-compliant
- Recurrent variceal bleeding, despite intensive therapy
3. Documentation of the following factors will support eligibility for hospice care:
- Progressive malnutrition
- Muscle wasting with reduced strength and endurance
- Continued active alcoholism (>80 gm ethanol/day)
- Hepatocellular carcinoma
- HBsAg (Hepatitis B) positivity
- Hepatitis C refractory to interferon treatment
Patients awaiting liver transplant who otherwise fit the above criteria may be certified for the Medicare hospice benefit, but if a donor organ is procured, the patient must be discharged from hospice.
If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. Contact your local Compassus program for further information.