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Liver Disease for Physicians

To qualify for hospice, patients must have:
  • Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio > 1.5
  • Serum albumin < 2.5 gm/dl

And exhibit at least one of the following:

  • Ascites, refractory to treatment or patient non-compliant
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Hepatic encephalopathy, refractory to treatment or patient non-compliance
  • Recurrent variceal bleeding, despite intensive therapy

The following factors support a hospital referral:

  • Progressive malnutrition
  • Muscle wasting with reduced strength and endurance
  • Continued active alcoholism (>80 gm ethanol/day)
  • Hepatocellular carcinoma
  • 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.