Liver Disease (Hospice Eligibility)

1 AND 2 SHOULD BE MET.

1. Labs (a and b should be met)
a. (i) Prothrombin time prolonged more than 5 seconds over control?
OR
a. (ii) International Normalized Ratio (INR) > 1.5?

b. Serum albumin < 2.5 gm/dl?

AND

2. Burden of Illness (at lease one should be met)
a. Acsites, refractory to treatment or patient non-compliant?
b. Spontaneous bacterial peritonitis?
c. Hepatorenal syndrome (elevated creatinine and BUN with oliguria (<400 ml/day) and urine sodium concentration < 10mEq/l)?
d. Hepatic encephalopathy, refractory to treatment, or patient non-compliant?
e. Recurrent variceal bleeding, despite intensive therapy?

OR

3. Supporting Factors
a. Progressive Malnutrition
b. Muscle wasting reduced strength and endurance?
c. Continued active alcoholism (>80 gm ethanol/day)?
d. Hepatocellular  carcinoma?
e. HBsAG (Hepatitis B) positivity?
f. Hepatitis C refractory to interferon treatment?