Mater Adult Hospital, Brisbane, Queensland, Australia.
Logan Hospital, Meadowbrook, Queensland, Australia.
J Gastroenterol Hepatol. 2021 Aug;36(8):2303-2306. doi: 10.1111/jgh.15499. Epub 2021 Mar 29.
End-stage liver disease is a leading cause of mortality. Fewer than 60% of patients with decompensated cirrhosis survive after 2 years, with patients often experiencing distressing symptoms impairing quality of life. Early advanced care planning and timely palliative care referral can improve quality of life and the end of life experience. We aimed to determine palliative care referral rates and patterns for patients admitted with decompensated cirrhosis, and to identify the factors associated with referral.
This was a retrospective, single-center study undertaken at a metropolitan tertiary referral hospital. Patients admitted between the 1 June 2016 and 31 January 2019 with a Child-Pugh score of B or C, and a model for end-stage liver disease score ≥ 15 were included. We assessed survival and compared those referred and not referred to palliative care, adjusting for lag-time to referral (Kaplan-Meier analysis).
One-hundred and sixteen admissions met eligibility criteria for referral. The median age at admission was 59 years, with 76% male participants. Only a fifth of eligible patients (25/116) were referred to palliative care. The median survival (from referral) for those referred to palliative care was 20 days, versus 148 days for those not referred.
Despite benefits from timely referral, less than one quarter of palliative care eligible patients was referred. Referral appears reserved for those facing imminent death-surviving just under 3 weeks postreferral, yet mortality in nonreferred patients remained high (148-day median). Low rates and late referral are a missed opportunity to improve the end of life care for patients with end-stage liver disease.
终末期肝病是主要的死亡原因之一。失代偿性肝硬化患者两年后生存率不足 60%，患者常经历影响生活质量的痛苦症状。早期进行先进的护理计划和及时转介姑息治疗可以提高生活质量和临终体验。我们旨在确定失代偿性肝硬化患者入院时转介姑息治疗的比例和模式，并确定与转介相关的因素。
这是一项在大都市三级转诊医院进行的回顾性单中心研究。纳入标准为 2016 年 6 月 1 日至 2019 年 1 月 31 日期间因 Child-Pugh 评分 B 或 C 且终末期肝病模型评分≥15 而入院的患者。我们评估了生存率，并比较了转介和未转介姑息治疗的患者，调整了转介时间（Kaplan-Meier 分析）。
符合转介条件的有 116 例入院。入院时的中位年龄为 59 岁，76%为男性。只有五分之一（25/116）符合条件的患者被转介至姑息治疗。接受姑息治疗的患者（从转介开始）的中位生存时间为 20 天，而未转介的患者为 148 天。
尽管及时转介有好处，但只有不到四分之一的姑息治疗合格患者被转介。转介似乎仅限于那些即将死亡的患者-转介后仅存活不到 3 周，但未转介患者的死亡率仍然很高（中位 148 天）。低比例和晚期转介是改善终末期肝病患者临终关怀的错失机会。
