S1172 Early Palliative Care Referral May Improve End of Life Care in End-Stage Liver Disease Patients. A Retrospective Analysis From a Non-Transplant Center

Abstract

Introduction: Patients with End Stage Liver Disease (ESLD) who are not transplant candidates often have a trajectory of rapid decline and death similar to patients with stage IV cancer. Palliative care (PC) services have been shown to be underutilized for such patients. Most studies examining the role of PC in ESLD have been done at transplant centers. Thus, determining the utilization and benefit of PC at a non-transplant tertiary center may help establish a standard of care in the management of transplant-ineligible patients with ESLD. Methods: We conducted a retrospective analysis of adult patients with ESLD admitted to Rochester Regional Health (RRH) system hospitals from 2012 to 2021. Patients were divided into groups based on presence (Group 1) or absence (Group 2) of PC involvement. Baseline characteristics were recorded. Impact of PC was assessed by comparing number of hospitalizations before and after PC referral, comparing code status changes, health care proxy (HCP) assignments, and requirement of repeated paracentesis. Results: 576 patients were analyzed of which 237 received a PC consult (Group 1) and 339 did not (Group 2). Baseline characteristics were comparable in both groups (Table). Mortality rate was significantly higher in group 1 than group 2 (83.1 vs 46.4%, p < 0.01). Changes in code status were higher in group 1 than in group 2 (77.6% vs 29.2%, p < 0.001). 59.9% in group I had comfort care code status and 67.8% in group 2 had full code. Patients in group 1 were more likely to have an HCP assigned (63.7% vs 37.5%, p < 0.001). Aspira catheter use (5.9% vs 0.9%, p < 0.001) and hospitalizations for frequent paracentesis (30.8% vs 16.8%, p < 0.001) were both more frequent in group 1. Mean number of emergency room visits or hospitalizations before the first PC consult was 15.6 and mean number of admissions after PC consult was 3.4 (P< 0.001). Conclusion: Our study shows that PC referral in patients with ESLD is associated with a higher rate of code status changes, HCP assignments and reduced hospitalizations. Patients receiving a PC referral were more likely to have a comfort care status while patients without a PC referral were more likely to be full code. Mortality rates at our non-transplant center were higher in patients with palliative care referral than those without. It suggests that patients did not receive a PC referral unless their disease severity was significant, however all patients with ESLD may benefit from early PC referral. Table 1. - Baseline characteristics and outcomes Variable PC involved (237) PC not involved (339) P-value Age (years) 64.61 64.07 0.58 Sex (% male) 57.40% 55.20% 0.59 Hepatocellular carcinoma 11 (4.6%) 12/339 (3.5%) 0.38 Transplant referral done 41 (17.3%) 72/339 (21.2%) 0.29 Mortality 196 (83.1%) 157 (46.4%) < 0.0001 Aspira catheter 14 (5.9%) 3 (0.9%) < 0.001 Frequent paracentesis 73 (30.8%) 57 (16.8%) < 0.001 TIPS procedure 8 (3.4%) 24 (7.1%) 0.06 Code status changes 184 (77.6%) 99 (29.2%) < 0.001 Full code 44 (18.6%) 230 (67.8%) < 0.001 Comfort care 142 (59.9%) 70 (20.6%) < 0.001 HCP assignments 151 (63.7%) 127 (37.5%) < 0.001