Annals of hepatology · 2026
The role of inpatient palliative care consultation in end-stage liver disease: Too little, too late?
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Wadhavkar Neha, Monteiro Joao Filipe G, Malani Kanika, Elfanagely Yousef, Promrat Kittichai
Аннотация
INTRODUCTION AND OBJECTIVES: Patients with end-stage liver disease (ESLD) often experience high symptom burden and frequent hospitalizations. Despite studiedbenefits ofpalliative care consultation services (PCCS), use in patients with ESLD is underutilizedand typically occurs weeks or days before death. Weexamined patterns of PCCS utilization, associated outcomes, and healthcare costs in hospitalized patients with ESLD.
PATIENTS AND METHODS: We retrospectively reviewed 3,983 patients (13,509 encounters) with ESLD from 2015-2023, excluding188 patients. We compared length of stay (LOS), mortality, disposition, readmissions, emergency department visits, and costs between patients receiving PCCS and those receivingusual care (UC), usingdescriptive analyses (Chi-square, Fisher's exact, and Student's t-tests)and multivariable logistic regression. Analyses were performed using SAS 9.4.
RESULTS: Among 12,821 hospitalizations, 6.3% involved PCCS. Because this denominator included all hospitalizations among patients with ESLD, we performed a diagnosis-based secondary analysis using principal problem, primary diagnosis, and diagnosis present on admission fields. Of classified encounters, 70.7% were non-liver primary admissions, 19.8% were supportive of possible ESLD/decompensation admissions, and 9.5% were definite ESLD/decompensation admissions. PCCS occurred in 9.4% of definite ESLD/decompensation admissions. These patients weremore likely to requiremechanical ventilation (OR 2.3, 95% CI [1.79-3.03]), paracentesis (1.9[1.16-3.0]), and ICUadmission (4.2[3.51-5.13]). Theyhad higher in-hospital and 30-day mortality (OR1.48[1.24-1.78] and OR3.1[2.39-3.89], respectively), decreased likelihood of discharge home (OR 0.58 [0.48-0.70]), longer LOS (16.2 versus 7.4 days, p<0.05), and higher total costs($59,684 versus $23,750, p<0.05). Among patients who died during hospitalization after receiving PCCS, the median interval from consultation to death was 7 days (IQR 3-13).
CONCLUSIONS: In this multihospital retrospective cohort, inpatient palliative care consultation in ESLD was uncommon and often occurred late in the hospitalization course. The overall encounter-level PCCS rate was partly influenced by inclusion of non-liver primary admissions, though PCCS utilization remained low, even among definite ESLD/decompensation admissions. Among in-hospital decedents who received PCCS, the short interval from consultation to death suggests late integration of palliative care near the end of life. Further prospective studies are needed to clarify optimal consultation timing and identify strategies to embed palliative care effectively within ESLD.
PATIENTS AND METHODS: We retrospectively reviewed 3,983 patients (13,509 encounters) with ESLD from 2015-2023, excluding188 patients. We compared length of stay (LOS), mortality, disposition, readmissions, emergency department visits, and costs between patients receiving PCCS and those receivingusual care (UC), usingdescriptive analyses (Chi-square, Fisher's exact, and Student's t-tests)and multivariable logistic regression. Analyses were performed using SAS 9.4.
RESULTS: Among 12,821 hospitalizations, 6.3% involved PCCS. Because this denominator included all hospitalizations among patients with ESLD, we performed a diagnosis-based secondary analysis using principal problem, primary diagnosis, and diagnosis present on admission fields. Of classified encounters, 70.7% were non-liver primary admissions, 19.8% were supportive of possible ESLD/decompensation admissions, and 9.5% were definite ESLD/decompensation admissions. PCCS occurred in 9.4% of definite ESLD/decompensation admissions. These patients weremore likely to requiremechanical ventilation (OR 2.3, 95% CI [1.79-3.03]), paracentesis (1.9[1.16-3.0]), and ICUadmission (4.2[3.51-5.13]). Theyhad higher in-hospital and 30-day mortality (OR1.48[1.24-1.78] and OR3.1[2.39-3.89], respectively), decreased likelihood of discharge home (OR 0.58 [0.48-0.70]), longer LOS (16.2 versus 7.4 days, p<0.05), and higher total costs($59,684 versus $23,750, p<0.05). Among patients who died during hospitalization after receiving PCCS, the median interval from consultation to death was 7 days (IQR 3-13).
CONCLUSIONS: In this multihospital retrospective cohort, inpatient palliative care consultation in ESLD was uncommon and often occurred late in the hospitalization course. The overall encounter-level PCCS rate was partly influenced by inclusion of non-liver primary admissions, though PCCS utilization remained low, even among definite ESLD/decompensation admissions. Among in-hospital decedents who received PCCS, the short interval from consultation to death suggests late integration of palliative care near the end of life. Further prospective studies are needed to clarify optimal consultation timing and identify strategies to embed palliative care effectively within ESLD.