| Liver disease |
| Patients will be considered to be in the terminal stage of liver disease (life expectancy of six months or less) if they meet the following criteria (1 and 2 should be present; factors from 3 will lend supporting documentation): |
- Both prolonged prothrombin time (more than five seconds over control, or INR >1.5) AND serum albumin <2.5 g/dL.
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- End stage liver disease with at least one of the following: 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.
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- Documentation of the following factors will support eligibility for hospice care: Progressive malnutrition; muscle wasting with reduced strength and endurance; continued active alcoholism (>80 g ethanol/day); hepatocellular carcinoma; HBsAg; hepatitis C infection refractory to interferon treatment.
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