10668Indiana University School of Medicine, Indianapolis, IN, USA.
Am J Hosp Palliat Care. 2021 Oct;38(10):1177-1181. doi: 10.1177/1049909120978768. Epub 2020 Dec 7.
Both obesity and end stage liver disease (ESLD) are increasing. Obesity's impact on hospice and palliative care in patients with ESLD is unknown.
We retrospectively evaluated patients admitted to an academic, Midwestern, tertiary center between January 2016 and May 2019 with a diagnosis of ESLD. Body Mass Index and MELD Na were calculated for each patient's first admission during the study period. Patients with MELD Na scores ≥ 21 or 18-20 with additional criteria were considered potentially eligible for hospice and palliative care referrals.
Of 3863 patients admitted with ESLD, 1556 (40%) were potentially eligible for hospice and palliative care referrals. Of these, 703 (45%) were obese. Comorbidity burden was higher in obese patients (15.6% of obese patients had a Charlson Comorbidity Index ≥ 5, while 5% of non-obese patients had a comorbidity index of ≥ 5 (p < 0.001). Referral rates to hospice and palliative services in obese patients were 10.1% and 16.4% respectively. Hospice and palliative referral rates among non-obese patients were similar (10.1% and 15.5%). Among patients who died within 6 months of the first hospitalization, the mean time to referral to hospice or palliative care from index admission was longer in obese patients.
Obesity is common in patients hospitalized with ESLD who may be approaching the end of life. Referral rates to hospice and palliative care services are low and similar regardless of BMI and despite higher co-morbidity burdens in obese patients. Obesity may delay referrals to hospice and palliative care.
肥胖和终末期肝病（ESLD）都在增加。肥胖对 ESLD 患者的临终关怀和姑息治疗的影响尚不清楚。
我们回顾性评估了 2016 年 1 月至 2019 年 5 月期间在一家中西部学术性三级中心住院的 ESLD 患者。为每位患者在研究期间的首次入院计算了体重指数（BMI）和 MELD Na。MELD Na 评分≥21 或 18-20 分且有其他标准的患者被认为有资格接受临终关怀和姑息治疗推荐。
在 3863 例 ESLD 患者中，有 1556 例（40%）可能有资格接受临终关怀和姑息治疗推荐。其中，703 例（45%）为肥胖患者。肥胖患者的合并症负担更高（15.6%的肥胖患者 Charlson 合并症指数≥5，而 5%的非肥胖患者的合并症指数≥5（p<0.001）。肥胖患者接受临终关怀和姑息治疗的推荐率分别为 10.1%和 16.4%。非肥胖患者的临终关怀和姑息治疗推荐率相似（10.1%和 15.5%）。在首次住院后 6 个月内死亡的患者中，肥胖患者从入院到接受临终关怀或姑息治疗的平均时间较长。
肥胖在因 ESLD 住院的患者中很常见，这些患者可能即将走到生命的尽头。尽管肥胖患者的合并症负担更高，但无论 BMI 如何，接受临终关怀和姑息治疗服务的推荐率都较低且相似。肥胖可能会延迟临终关怀和姑息治疗的推荐。
