A Retrospective Review: Early Versus Late Palliative Care for People With End Stage Liver Disease

Abstract

Background

Although early palliative care (PC) has been shown to have numerous benefits for critically ill patients, including those with chronic organ failure, its use remains underutilized in patients with decompensated cirrhosis or end-stage liver disease. In this study, we examine the timing of consultations and their correlation to patient outcomes.

Objectives

Evaluate the association between timing of early vs late inpatient PC consults (within or after 72 h since admission) for patients with decompensated cirrhosis on the days from consult to discharge (DCD), length of stay (LOS), and inpatient deaths. Demographics were obtained from the electronic medical records.

Methods

This retrospective cohort study examined 256 inpatient PC encounters admitted with a diagnosis of end-stage liver disease. Patient information was collected from four hospitals in the U.S. from 1/25/2020 to 8/1/2024. Data was analyzed using descriptive statistics, chi-square test, and t-test.

Results

Of the 256 encounters, 142 (55.5%) were in the early cohort. These patients had a significantly lower DCD when compared to the late cohort (P = 0.0045), as well as a significant reduction in LOS (P = 2.09xe-28). Early cohorts had fewer inpatient deaths (28%) compared to late consults (43%). Although not statistically significant, discharges to hospice and home were more likely to have early PC consult compared to late.

Conclusions

Early PC intervention was associated with significantly improved primary and secondary outcomes including DCD, LOS, and inpatient deaths. Further research is needed to focus PC efforts on this high-risk, underserved population.