Liver Disease

Liver Disease

Patients will be considered to be in the terminal stage of liver disease if they meet the following criteria: Both 1 and 2 should be present; factors from 3 will lend supporting documentation:

• The patient should show both criteria below:
• • Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR) > 1.5.
• • Serum albumin < 2.5 gm/dl.


• End-stage liver disease is present and the patient shows AT LEAST ONE criteria below:
• • Ascites, refractory to treatment or patient non-compliant.
• • Spontaneous bacterial peritonitis.
• • Hepatorenal syndrome (elevated creatinine and BUN with oliguria < 400 ml/day and urine sodium concentration < 10 mEq/l).
• • Hepatic encephalopathy, refractory to treatment or patient non-compliant.
• • Recurrent variceal bleeding, despite intensive therapy.


• Documentation of the following factors will support eligibility for hospice care:
• • Progressive malnutrition.
• • Muscle wasting with reduced strength and endurance.
• • Continued active alcoholism (> 80 gm ethanol/day).
• • Hepatocellular carcinoma.
• • HBsAg (Hepatitis B) positivity.
• • Hepatitis C refractory to interferon treatment.