What Is The Life Expectancy Of Patient With Decompensated Liver With CTP?

Question: 65yoF with cirrhosis from Hepatitis C contracted in 1970's. She went through anti-viral tx about 2-3 yrs ago and has been told virus is gone. Pt. has hx of portal hypertension on Propanolol, has had esophageal varices that have been banded, has pleural effusion she says she is on Coumadin for, takes Xifaxan for hepatic encephalopathy. Pt. went without Xifaxan for 3 days and had significant symptoms--has been on Xifaxan for several months and supposes she will stay on it. Having depression symptoms on Lexapro and on Prilosec and also Ultram. Takes Lasix and Spironolactone for edema--has significant edema both lower extremities. Latest blood work showed platelets--30,000, bilirubin at 2.9, creatinine at .84, albumin at 3.1, INR at 1.7 and Hgb at 10. Pt. had cholecystectomy about 1 1/2 yrs ago and surgeon told the husband the cirrhosis looked really bad. What kind of life expectancy would be expected with this patient? She is not open with family members about her condition and I imagine it has to do with her depressive state. Thank you for any information you can give. Pt. also has been on Levaquin twice since XXXXXXX , 2016 for UTI and has been on a course of Prednisone for pruritis. Pt. has clubbing, palmar erythema, muscle wasting, anorexia, has been jaundiced in the past but now has grayish-ashen coloring, hair loss and in the last 3 months has aged tremendously.


Forgot to mention she also sleeps 16-18 hours daily. When she has a good day and is up and doing laundry or cooking a little, she is usually down for the next 3-5 days without doing anything.

Thank you very much for your response. I, too, have thought she would be a CTP class C, even though she says she is compensated. I think she is just in denial and refuses to discuss her condition with anyone, her husband especially. Her varices WERE banded and she says they have "scarred over". She does go for routine endoscopy and no new varices have had to be taken care of. As far as ascites, patient says she does NOT have ascites but I'm thinking she probably has minimal (she has NOT had to be tapped yet) ascites but the edema is pitting with the right leg swelling worse than the left. When I questioned her on the leg swelling, she said it was because of "bad veins" in her legs but I didn't believe that story. My biggest concern has been her encephalopathy--her husband has noticed the last 2 months that she has had trouble taking care of her finances and she has had to rely on him to take care of some bills that she is responsible for. I told him he needs to take over but he is not willing to do that at this point. She is also still driving when she wants to go somewhere. I have also told him that is not a safe situation but he says until the Dr. tells her she can't drive he won't take her keys away. I told him I would imagine the Dr. has already told her that but that she is going to do what she wants to do.

I don't know how compliant she is with her meds but with her in bed and sleeping as much as she does, I don't know how she could be that compliant. She is on liver transplant list but I would doubt she would get a liver due to her age and low MELD score of 16.

With her pleural effusion, I don't know how much lung involvement has taken place and I know with her lab values that there is some kidney involvement. I'm thinking she could, at any time, take a downward turn and die. I also forgot to mention that about a year ago she had been on Dilaudid for pain and the husband had to admit her to the hospital for an overdose. Since then, she has not been allowed to have any opiates. I told the husband that she may be having significant pain that the Ultram is not controlling and that he may want to consider letting her have stronger pain meds at some point.

This patient is an RN and has told her husband that she doesn't need anyone to care for her, that she is totally able to take care of herself. Thank you again for your time and your response. I really appreciate the feedback.