From the Guidelines
Liver decompensation is characterized by the development of ascites, encephalopathy, gastrointestinal haemorrhage, or any combination of these disorders in patients with cirrhosis, as defined by the European Association for the Study of the Liver (EASL)-Chronic Liver Failure (CLIF) Consortium 1. The signs and symptoms of liver decompensation can be severe and life-threatening, and may include:
- Jaundice (yellowing of skin and eyes)
- Ascites (fluid accumulation in the abdomen)
- Hepatic encephalopathy (confusion, drowsiness, and personality changes)
- Coagulopathy (easy bruising and bleeding)
- Esophageal varices that may rupture and cause life-threatening bleeding
- Peripheral edema (swelling in legs and ankles)
- Spider angiomas (spider-like blood vessels on the skin)
- Palmar erythema (reddening of palms)
- Muscle wasting These manifestations result from the liver's inability to detoxify substances, produce clotting factors and proteins, and maintain portal blood flow 1. Laboratory findings typically show elevated bilirubin, decreased albumin, prolonged prothrombin time, and thrombocytopenia 1. It is essential to note that acute-on-chronic liver failure (ACLF) is a severe form of acutely decompensated cirrhosis, associated with a 28-day mortality rate of 20% or more, and is characterized by the functional failure of one or more of the six major organ systems (i.e., liver, kidney, brain, coagulation, circulation, and respiration) and systemic inflammation 1. Management of liver decompensation includes treating the underlying cause, sodium restriction, diuretics, paracentesis for severe ascites, lactulose for encephalopathy, and beta-blockers for varices 1. Patients with these symptoms require urgent medical attention as they indicate advanced liver disease with poor prognosis without intervention 1.
From the Research
Signs and Symptoms of Liver Decompensation
The signs and symptoms of liver decompensation can vary depending on the underlying cause of the liver disease. Some common signs and symptoms include:
- Ascites: the accumulation of fluid in the abdominal cavity 2, 3, 4, 5, 6
- Jaundice: a yellowing of the skin and eyes due to a buildup of bilirubin in the blood 2, 4, 5, 6
- Variceal bleeding: bleeding from enlarged veins in the esophagus or stomach 2, 3, 4, 5, 6
- Hepatic encephalopathy: a condition characterized by confusion, altered mental status, and coma 2, 4, 5, 6
- Spontaneous bacterial peritonitis: an infection of the fluid in the abdominal cavity 2
- Hepatorenal syndrome: a condition characterized by kidney failure in patients with liver disease 2, 3, 4
- Hepatocellular carcinoma: a type of liver cancer 2, 5
Patterns of Decompensation
The pattern of decompensation can vary depending on the underlying cause of the liver disease. For example:
- Alcoholic liver disease is more commonly associated with ascites as the initial pattern of decompensation 2
- Non-alcoholic liver disease is more commonly associated with hepatocellular carcinoma as the initial pattern of decompensation 2
- Patients with decompensated cirrhosis due to hepatitis B virus infection may benefit from antiviral therapy 5
Management of Liver Decompensation
The management of liver decompensation depends on the underlying cause of the liver disease and the specific signs and symptoms present. Some common management strategies include: