Attributes and outcomes of end stage liver disease as compared with other noncancer patients admitted to a geriatric palliative care unit

Background: End stage liver disease (ESLD) is increasingly more prevalent as a noncancer disease to manage in palliative care. Because of the clear lack of a "terminal phase" in ESLD, palliative care is often initiated only when death is perceived as being imminent. Palliative care units (PCUs) serve as an option for continued care for patients living with ESLD and are a limited resource, often not able to accommodate longer patient admissions. Concerns have been raised that ESLD patients may be admitted late in their disease course, not allowing for equitable access to such a service because of a perceived longer length of stay (LOS). The aim of this study is to better characterize the illness experience of patients with ESLD on a geriatric PCU comparing ESLD patients and other noncancer patients in terms of admission PPS, estimated prognosis and LOS. Methods: This was a single-center retrospective chart review of all noncancer patients admitted to Baycrest Health Sciences Palliative Care Unit (PCU) in Toronto, Canada over a four-year period. We measured the association between demographic data, estimated prognosis, Palliative Performance Score (PPS), and LOS between patients with ESLD and other noncancer diagnoses. Results: There were 235 patients with noncancer diagnoses admitted to the PCU during the study period, of which 19% had ESLD. Patients with ESLD were both significantly younger (P<0.001) and were admitted with a significantly higher PPS (P<0.001) than patients with other noncancer diagnoses. Estimated prognoses for patients with ESLD compared to other noncancer patients were similar. There were no significant difference in LOS between patients with ESLD and other noncancer patients (P=0.18), although there was a non-significant trend towards a shorter LOS for patients with ESLD. There was no significance in disposition (P=0.30); the vast majority of patients with ESLD and other noncancer diagnoses died on the PCU. Conclusions: Patients with ESLD were younger and had a higher PPS score with no significant difference in estimated prognosis, LOS, or disposition when compared to other noncancer patients. Our findings suggest that patients with ESLD have a short LOS on the PCU with a unique illness experience compared to other noncancer patients.