From the Guidelines
Acute decompensation of liver cirrhosis is characterized by the development of overt clinical signs, including ascites, bleeding, encephalopathy, and jaundice, which indicate a serious deterioration in liver function and require immediate medical attention. The natural history of cirrhosis is marked by an asymptomatic compensated phase followed by a decompensated phase, with the most frequent signs being ascites, bleeding, encephalopathy, and jaundice 1. These signs are a result of the liver's inability to perform its essential functions, leading to portal hypertension, varices, and ascites, as well as the accumulation of toxins that cause encephalopathy.
Key Clinical Signs
- Jaundice (yellowing of the skin and eyes)
- Ascites (fluid accumulation in the abdomen)
- Hepatic encephalopathy (confusion, disorientation, and altered consciousness)
- Gastrointestinal bleeding (from esophageal or gastric varices)
- Coagulopathy (easy bruising and bleeding)
- Hepatorenal syndrome (kidney dysfunction) Patients may also experience worsening fatigue, increased abdominal pain, fever, and infections, with laboratory findings showing elevated bilirubin, decreased albumin, prolonged prothrombin time, and elevated ammonia levels 1.
Management and Prognosis
The development of these complications can accelerate the progression of the disease, and the mortality rate remains high if not promptly addressed 1. Therefore, it is crucial to recognize these signs and provide immediate medical attention to improve patient outcomes. The prognosis of patients with decompensated cirrhosis is poor, with 1-year and 2-year survival rates of 60% and 45%, respectively, highlighting the need for prompt and effective management 1.
From the Research
Signs of Acute Decompensation Liver Cirrhosis
The signs of acute decompensation liver cirrhosis include:
- Ascites [(2,3,4)]
- Gastrointestinal bleeding [(2,3,4,5)]
- Hepatic encephalopathy [(2,3,4)]
- Bacterial infection 3
- Extrahepatic organ dysfunction 3
Characteristics of Acute Decompensation
Acute decompensation in patients with liver cirrhosis is often accompanied by further extrahepatic organ dysfunction 3 and has a high mortality risk [(3,6)]. The development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection characterizes acute decompensation 3.
Clinical Consequences of Portal Hypertension
Portal hypertension is a major complication of cirrhosis and can lead to several clinical consequences, including: