The following factors have been shown to correlate with poor short-term survival in advanced cirrhosis of the liver due to alcoholism, hepatitis, or uncertain causes (cryptogenic). Their effects are additive, i.e., prognosis worsens with the addition of each one and clinical judgment is vital. The following factors should be followed and reviewed over time.

1. Patient is not a candidate for liver transplant.

2. Laboratory indicators of severely impaired liver function should show both of the following:

_____Prothrombin time prolonged more than 5 sec. over control
_____ Serum albumin < 2.5 gm/dl

3. Clinical indicators of end-stage liver disease (Patient should show at least one of the following):

____ Ascites
____ Patient Non-compliant
____ Refractory to sodium restriction and diuretics:
spironolactone 75-150 mg/day plus furosemide > 40 mg/day
____ Spontaneous bacterial peritonitis (median survival 30% at one year; high mortality even when infection cured initially if liver disease is severe or accompanied by renal disease)
____ Hepatorenal syndrome (usually occurs during hospitalization; survival generally days to weeks)

____ patient has cirrhosis and ascites
____ elevated creatinine and BUN
____ oliguira 400 ml/da
____ urine sodium concentration < 10 mEq/l

____ Hepatic encephalopathy

____ refractory to protein restriction and lactulose or neomycin
____ patient non-compliant

____ Recurrent variceal bleeding: patient should have re-bled despite therapy which currently includes:

____ injection sclerotherapy or band ligation, if available
____ oral beta blockers
____ transjugular intrahepatic portosystemic shunt (TIPS)
____ patient refused further therapy

4. The following factors have been shown to worsen prognosis:

____ progressive malnutrition
____ muscle wasting with reduced strength and endurance
____ continued active alcoholism (> 80 g ethanol per day)
____ hepatocellular carcinoma
____ HBsAg positivity