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What Is The Life Expectancy Of Patient With End Stage Cirrhosis?
Question: I'm concerned about a family member--65yoF with end stage cirrhosis. Pt. was diagnosed 2-3 yrs ago with cirrhosis following episode of esophageal variceal bleeding. Those varices were banded and pt. was put on Propanolol and has had no recurrence of variceal bleeding. Pt. has history of pleural effusion, hepatic encephalopathy on Xifaxan daily and recently has developed minimal ascites--just beginning to show evidence of this with "poochy stomach". Latest blood work indicates 30,000 platelets, bilirubin-2.9, WBC-2.8, RBC-3.68, Na+-140, BUN-19, Crea.-.84 and Albumin-3.1. Pt. has long-standing history of bilateral edema with right leg worse swelling than the left. Pt. had cholecystectomy about 1 1/2 yrs ago and almost bled out on the table. The surgeon told the husband after surgery that he saw the liver and it looked "really bad." Pt. went without Xifaxan for 3 days last month and had significant issues and immediately got back on the med. Pt. contracted disease from Hepatitis C that she contracted from a needle stick back in the 1970's. Pt. went
through anti-viral treatment 2 yrs ago and says she is virus free. Pt. also takes Lexapro for depression and is also on Prilosec and Ultram. Pt. one yr. ago was taking Dilaudid for pain and had to be admitted to hospital for overdose. Since then, she has not been allowed to have opiates. Pt. has clubbing, palmar erythema, muscle wasting, anorexia, has been jaundiced in the past but is now an ashen-gray color, has hair loss and in the last 3 months has aged tremendously. Not uncommon for pt. to sleep 16-18 hrs. daily. When she has a good day, she may be up several hrs., do laundry or minimal cooking but then needs to be in bed for several days. Last 2 months pt. has had some trouble with her finances. Pt. is not open with anyone about her medical condition and her husband is left completely in the dark. Forgot to mention pt. is on Lasix and Spironolactone for the edema and she takes a pill for nausea PRN. What kind of life expectancy would this patient have? MELD score from latest blood work indicated 16. I'm concerned for her safety as she still continues to drive.
through anti-viral treatment 2 yrs ago and says she is virus free. Pt. also takes Lexapro for depression and is also on Prilosec and Ultram. Pt. one yr. ago was taking Dilaudid for pain and had to be admitted to hospital for overdose. Since then, she has not been allowed to have opiates. Pt. has clubbing, palmar erythema, muscle wasting, anorexia, has been jaundiced in the past but is now an ashen-gray color, has hair loss and in the last 3 months has aged tremendously. Not uncommon for pt. to sleep 16-18 hrs. daily. When she has a good day, she may be up several hrs., do laundry or minimal cooking but then needs to be in bed for several days. Last 2 months pt. has had some trouble with her finances. Pt. is not open with anyone about her medical condition and her husband is left completely in the dark. Forgot to mention pt. is on Lasix and Spironolactone for the edema and she takes a pill for nausea PRN. What kind of life expectancy would this patient have? MELD score from latest blood work indicated 16. I'm concerned for her safety as she still continues to drive.
Brief Answer:
I am afraid, with these complications prognosis isn't much better
Detailed Answer:
Hi! Welcome to health care magic! Thanks for sharing your concerns with us . We will try to help you in best way possible.
First of all, it is sad to know what your closed one is going through. Unfortunately the final treatment would have been a liver transplant but since her age is little late for that but final opinion should be taken by a liver transplant surgeon. Meanwhile treatment should be aimed at supportive care. It includes avoidance of constipation with a stools frequency of 2-4 per day as to avoid development of Porto systemic encephalopathy. Similarly a closed watch at development of black stools or blood stained vomiting as in that case coagulpathy should be addressed as well as surveillance endoscopy from time to time, and not late than six months and banding of varices if present. Similarly urine making drugs to decrease fluid accumulation in abdomen and occasional use of antibiotics like ciprofloxacin weekly to avoid infection in this fluid. Decreasing protien intake and rest as well as salt restriction should be ensured. The treatment you have shared, does encompass a balanced treatment regimen. Life expectancy depend on all these factors and development of all these complications including few more life threatening ones including hepatorenal or hepatopulmonary syndromes. Wish her a better health. If you have any more questions, feel free to ask. Regards.
I am afraid, with these complications prognosis isn't much better
Detailed Answer:
Hi! Welcome to health care magic! Thanks for sharing your concerns with us . We will try to help you in best way possible.
First of all, it is sad to know what your closed one is going through. Unfortunately the final treatment would have been a liver transplant but since her age is little late for that but final opinion should be taken by a liver transplant surgeon. Meanwhile treatment should be aimed at supportive care. It includes avoidance of constipation with a stools frequency of 2-4 per day as to avoid development of Porto systemic encephalopathy. Similarly a closed watch at development of black stools or blood stained vomiting as in that case coagulpathy should be addressed as well as surveillance endoscopy from time to time, and not late than six months and banding of varices if present. Similarly urine making drugs to decrease fluid accumulation in abdomen and occasional use of antibiotics like ciprofloxacin weekly to avoid infection in this fluid. Decreasing protien intake and rest as well as salt restriction should be ensured. The treatment you have shared, does encompass a balanced treatment regimen. Life expectancy depend on all these factors and development of all these complications including few more life threatening ones including hepatorenal or hepatopulmonary syndromes. Wish her a better health. If you have any more questions, feel free to ask. Regards.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you Dr. Ulabidin for your response. I have some added information that may be helpful for further consideration.
The patient is being treated by a hepatologist at the University of XXXXXXX and she is on the liver transplant list, however, family is aware with her age and blood type she will probably not receive a liver. Patient does have recurrent hepatic encephalopathy, therefore, the need for daily Xifaxan. Patient is a retired RN so she is well aware of complications and treatment for them. She also has endoscopy yearly and has been told the banded varices have "scarred over".
I did forget to mention that she has been on Levaquin twice since January, 2016 for UTI and she did take a course of Prednisone for pruritis.
Since she does have or has had pleural effusion, I'm assuming that would give rise to problems with the lungs. What symptoms would be evident with hepatopulmonary syndrome?
Again, could you give an estimation on what her life expectancy would be? Any information is greatly appreciated by family members since she refuses to discuss her health issues.
The patient is being treated by a hepatologist at the University of XXXXXXX and she is on the liver transplant list, however, family is aware with her age and blood type she will probably not receive a liver. Patient does have recurrent hepatic encephalopathy, therefore, the need for daily Xifaxan. Patient is a retired RN so she is well aware of complications and treatment for them. She also has endoscopy yearly and has been told the banded varices have "scarred over".
I did forget to mention that she has been on Levaquin twice since January, 2016 for UTI and she did take a course of Prednisone for pruritis.
Since she does have or has had pleural effusion, I'm assuming that would give rise to problems with the lungs. What symptoms would be evident with hepatopulmonary syndrome?
Again, could you give an estimation on what her life expectancy would be? Any information is greatly appreciated by family members since she refuses to discuss her health issues.
Brief Answer:
Estimation of life depends upon supportive care and complications
Detailed Answer:
Hi! Thanks for keeping me in the loop. I can understand your concerns, regarding her well being and the trauma your family must be going through. Yes, these symptoms can be of hepatopulmonary syndrome but it is also a diagnosis of exclusion, that is after ruling out other causes like respiratory tract infections and other inflammatory causes in lungs or airways. Exact life estimation depends upon the supportive care. If follow up and compliance to treatment is good then patient can survive upto few more years. But in absence of these such illness it may take weeks to months to cause fatal outcomes. Development of Hepatorenal syndrome also decreases the life expectancy very quickly down to few months. Hope this has answered your query, if you have any more questions, feel free to ask. Regards.
Estimation of life depends upon supportive care and complications
Detailed Answer:
Hi! Thanks for keeping me in the loop. I can understand your concerns, regarding her well being and the trauma your family must be going through. Yes, these symptoms can be of hepatopulmonary syndrome but it is also a diagnosis of exclusion, that is after ruling out other causes like respiratory tract infections and other inflammatory causes in lungs or airways. Exact life estimation depends upon the supportive care. If follow up and compliance to treatment is good then patient can survive upto few more years. But in absence of these such illness it may take weeks to months to cause fatal outcomes. Development of Hepatorenal syndrome also decreases the life expectancy very quickly down to few months. Hope this has answered your query, if you have any more questions, feel free to ask. Regards.
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Above answer was peer-reviewed by :
Dr. Sonia Raina
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