C0506 - Outcomes of Patients With Decompensated Cirrhosis With Limited Life Expectancy or Anticipated Transplant in the Context of a Health Services Intervention Trial

Ashley V. Maveddat, MD¹, Malaz Boustani, MD², Nicole Fowler, PhD², Noll Campbell, PharmD³, Archita Desai, MD¹, Eric Orman, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²Indiana University, Indianapolis, IN; ³Purdue Dept of Pharmacy Practice, Indianapolis, IN

Introduction: Intervention studies for patients with cirrhosis that are aimed at improving quality of life for patients and reducing healthcare utilization often exclude those with limited life expectancy or those being evaluated for a liver transplant. However, excluding such patients creates a dearth of evidence on clinic interventions that are impactful and potentially scalable. We aimed to examine outcomes of patients excluded from a randomized trial due to limited life expectancy or anticipated transplant.

Methods: This is a cohort study of hospitalized patients with decompensated cirrhosis who were excluded from a randomized trial of health services intervention due to life expectancy < 6 months (too sick) or anticipated transplant < 6 months (likely transplant). These assessments were made by a team of investigators and incorporated standard measures of disease severity (i.e. MELD). Patients were followed from the time of screening for 6 months to assess outcomes, such as hospitalizations, death, and transplant.


Results: Out of 127 patients screened, 64 (50%) were excluded due to being too sick (n=39) or likely transplant (n=25). The mean age was 57, and 38% were female. Cirrhosis etiology was alcohol in 39% and NASH in 34%. The mean MELD-Na was 26. Those deemed too sick and likely transplant had similar characteristics at screening but with a trend toward more women in the likely transplant group (Table). Of the too sick, 60% discharged to hospice or died in the hospital. 28% of likely transplants discharged to hospice or died in the hospital, and only 48% of likely transplants received a transplant. In the too sick group, 56% saw palliative care compared to 12% in the likely transplant group. Those who saw palliative care were older, with more comorbidities including hepatocellular carcinoma. Palliative care was associated with discharge to hospice, and no patient who saw palliative care received a transplant. Overall, of those who died, 78% died in the hospital, but only 50% who saw palliative care died in the hospital.


Discussion: During screening for a randomized trial of hospitalized patients with decompensated cirrhosis, half were excluded due to limited life expectancy or anticipated transplant, and prediction of 6-month outcomes were inaccurate. Palliative care was associated with fewer deaths in the hospital. Health services trials should include patients with advanced disease and incorporate principles of palliative care, which may improve some patient-centered outcomes.


Disclosures:


Ashley V. Maveddat, MD¹, Malaz Boustani, MD², Nicole Fowler, PhD², Noll Campbell, PharmD³, Archita Desai, MD¹, Eric Orman, MD¹. C0506 - Outcomes of Patients With Decompensated Cirrhosis With Limited Life Expectancy or Anticipated Transplant in the Context of a Health Services Intervention Trial, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.