Towards a new definition of decompensated cirrhosis

Abstract

There is a universal agreement that the occurrence of clinical complications, such as ascites, hepatic encephalopathy, gastrointestinal bleeding, and jaundice mark the transition from the compensated to the decompensated stage of cirrhosis. Decompensation is associated with a substantial worsening of patient prognosis and is therefore considered the most important stratification variable for the risk of death. However, this classification is an oversimplification, as it does not discriminate between the prognostic subgroups that characterise the course of decompensation, which depends on the type and number of decompensating events. A deeper insight into the clinical course of decompensated cirrhosis is provided by observational studies characterising acute decompensation (AD), which occurs mostly in patients who have already experienced decompensating events. Decompensation presents as AD in a portion of patients while in many others it presents as a slow development of ascites or mild grade 1 or 2 hepatic encephalopathy, or jaundice, not requiring hospitalisation. Thus, we propose that decompensation of cirrhosis occurs through 2 distinct pathways: a non-acute and an acute (which includes acute-on-chronic liver failure) pathway. Moreover, while non-acute decompensation is the most frequent pathway of the first decompensation, AD mostly represents further decompensation.

Pathophysiologie der Dekompensation bei Leberzirrhose – Prognose-Scores

“…Die zuvor genannten hämodynamischen Veränderungen erklären nur unzureichend, was den Übergang der kompensierten Leberzirrhose in das Stadium der Dekompensation bewirkt. Der Übergang kann entweder schleichend sein (non-acute decompensation), d. h. mit milden klinischen Veränderungen einhergehen (langsam zunehmender Aszites, HE-Grad 1-2, zunehmender Ikterus) oder sich als akute Dekompensation (AD) präsentieren [4]. In den letzten Jahren konnten mehrere Studien zeigen, dass das Auftreten von Komplikationen mit einem Anstieg von Entzündungswerten (Leukozytenzahl, CRP, proinflammatorische Zytokine) assoziiert ist.…”

Increased Serum Levels of sCD206 Are Associated with Adverse Prognosis in Patients with HBV-Related Decompensated Cirrhosis

“…Decompensated cirrhosis (DeCi) is a common and serious liver disease that develops mainly in chronic hepatitis B (CHB) patients in Asia and is a disease state in which patients with cirrhosis develop variceal bleeding, ascites, hepatic encephalopathy (HE), or jaundice [ 3 ]. Once decompensation occurs, cirrhosis becomes a systemic disease with multiorgan dysfunction [ 4 ]. The median survival time drops from more than 12 years for the compensated state to approximately 2 years for the decompensated state due to these events [ 5 ].…”

Clinical Characteristics and Outcomes of Decompensated Cirrhosis Patients Admitted to Hospitals With Acute Pulmonary Embolisms: A Nationwide Analysis

“…The natural history of liver cirrhosis can be divided into two phases: a compensated and a decompensated phase. Although this classification can oversimplify the clinical course, it is useful in terms of expecting the quality of life as well as determining the prognosis and median survival rates [ 4 ]. Decompensated cirrhosis (DC) lacks a consensus on definition; however, it is characterized by the development of cirrhosis-related complications, including ascites, hepatic encephalopathy, variceal bleeding, and spontaneous bacterial peritonitis, hepatocellular carcinoma, or hepatorenal syndrome.…”

“…Decompensated cirrhosis (DC) lacks a consensus on definition; however, it is characterized by the development of cirrhosis-related complications, including ascites, hepatic encephalopathy, variceal bleeding, and spontaneous bacterial peritonitis, hepatocellular carcinoma, or hepatorenal syndrome. Despite the fact that the median survival in those patients is 2-4 years in comparison to more than 12-year median survival for those with compensated cirrhosis [ 4 ], the outcome can be unpredictable, as it ranges from the resolution of the acute decompensation to rapid progression of multiorgan failure and death [ 5 ].…”