From the Guidelines
Decompensated cirrhosis, also known as liver cirrhosis stage 4, is characterized by the development of overt clinical signs such as ascites, bleeding, encephalopathy, and jaundice, and requires comprehensive management to improve quality of life and reduce morbidity and mortality. The characteristics of liver cirrhosis stage 4 include extensive fibrosis and architectural distortion of the liver, with a high risk of developing complications such as variceal hemorrhage, ascites, hepatic encephalopathy, and spontaneous bacterial peritonitis 1. The management of decompensated cirrhosis involves addressing the underlying cause of cirrhosis, such as abstinence from alcohol, antiviral therapy for hepatitis, or weight loss for fatty liver disease, and managing complications with medications such as non-selective beta-blockers, diuretics, and lactulose 1. Key aspects of management include:
- Regular monitoring by a hepatologist every 3-6 months
- Screening for complications including upper endoscopy, ultrasound with alpha-fetoprotein testing, and regular assessment for ascites, hepatic encephalopathy, and coagulopathy
- Avoiding hepatotoxic medications, limiting sodium intake, and abstaining from alcohol
- Evaluation for liver transplantation The pathophysiology of decompensated cirrhosis involves a complex interplay of haemodynamic disturbances, immune dysfunction, and multi-organ/system dysfunction, and current strategies for management rely on measures aimed at preventing or improving the outcome of each complication 1. Proper management of decompensated cirrhosis can slow progression and improve quality of life, and it is essential to prioritize the single most recent and highest quality study, which in this case is the 2024 AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis 1.
From the Research
Characteristics of Liver Cirrhosis Stage 4
Liver cirrhosis stage 4, also known as decompensated cirrhosis, is characterized by:
- Ascites, which is the accumulation of fluid in the peritoneal cavity 2
- Spontaneous bacterial peritonitis, which is an infection of the fluid in the peritoneal cavity 2, 3
- Hepatic encephalopathy, which is a condition characterized by cognitive disturbances, ranging from mild confusion to coma 2, 3
- Variceal bleeding, which is bleeding from enlarged veins in the esophagus or stomach 2, 3
- Portal hypertension, which is high blood pressure in the portal vein, the vein that carries blood from the intestines to the liver 4
Diagnosis and Evaluation
Diagnosis of liver cirrhosis stage 4 is typically made through a combination of:
- Physical examination 5, 3
- Laboratory tests, such as liver function tests and complete blood count 6, 5, 3
- Imaging studies, such as ultrasonography and transient elastography 6, 3, 4
- Liver biopsy, which is the gold standard for diagnosis and staging of cirrhosis 5, 3, 4
Management and Treatment
Management and treatment of liver cirrhosis stage 4 typically involve: