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Palliative Care, Patient-Reported Measures, and Outcomes in Hospitalized Patients With Cirrhosis
Eric S Orman1, Andrew Yousef1, Chenjia Xu1
1Division of Gastroenterology and Hepatology (E.S.O., L.N., M.G., A.P.D., K.R.P., N.C.), Indiana University, Indianapolis, Indiana, USA; Department of Medicine (A.Y., H.S.), Indiana University, Indianapolis, Indiana, USA; Department of Biostatistics and Health Data Science (C.X.), Indiana University, Indianapolis, Indiana, USA; Division of General Internal Medicine and Geriatrics (A.W.J.), Indiana University, Indianapolis, Indiana, USA.
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.
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