Abstract

Background: The majority of patients suffering from end-stage liver disease (ESLD) experience a predictable decline in quality of life and physical function, as well as significant psychological distress. They are frequently hospitalized and are relatively less likely to be referred to palliative care. This study aims to elucidate whether patients with terminal disease receive appropriate management.

Methods: We retrospectively reviewed 236 patients with liver cirrhosis who were hospitalized in the intensive care unit between August 2013 and July 2015 in Taitung Mackay Memorial Hospital, Taiwan. The basic patients' information, laboratory results, prognosis, medical cost are collected. We further calculate the number of invasive medical procedure or life-sustaining therapy of end-stage patients before death.

Results: The overall in-hospital mortality rate was 35.2%. We subdivided patients into higher severity and lower severity groups. Several factors were not statistically different between the two categories, including sex, cirrhosis etiology, length of hospital stay, and hospital cost. In the higher severity group, 61.9% patients died during hospitalization. Among these patients, 68.9% DNR consent was given by a surrogate decision-maker within the 24 hours prior to death. Even among those with terminal disease status, many received life-support management in the pre-dying period.

Conclusion: Many end-stage cirrhotic patients received inappropriate life-support intervention during hospitalization, even during the pre-dying period. Identification of markers that can reliably predict prognosis in patients with cirrhosis and early introduction of adequate palliative care prior to the terminal disease phase may help to improve physical and psychological outcomes.