Certain findings in a patient with end-stage liver disease indicate that the patient's expected survival will be 6 months or less.
Parameters:
(1) laboratory findings
(2) clinical findings
Laboratory findings:
(1) hypoprothrombinemia (prothrombin time > 5 seconds beyond upper limit of normal control, or INR > 1.5)
(2) hypoalbuminemia (serum albumin < 2.5 g/dL)
where:
• Anticoagulation with coumadin would mask prolonged PT. In severe liver disease the prolongation in the PT is not responsive to vitamin K.
Clinical findings:
(1) ascites refractory to sodium restriction and diuretics
(2) spontaneous bacterial peritonitis
(3) hepatorenal syndrome
(4) hepatic encephalopathy refractory to protein restriction and lactulose
(5) recurrent variceal bleeding
Criteria for poor survival:
(1) both laboratory findings
(2) one or more clinical findings
Additional factors indicating a poor prognosis:
(1) progressive malnutrition
(2) muscle wasting
(3) active alcoholism
(4) hepatocellular carcinoma (unresectable)
(5) positive hepatitis B surface antigen (chronic active hepatitis)
where:
• I have seen alcoholics with these findings who have had a prolonged survival if they stopped drinking.
