From the Guidelines
Decompensated liver cirrhosis is diagnosed when a patient with established cirrhosis develops complications such as ascites, variceal bleeding, hepatic encephalopathy, or jaundice, as defined by the most recent guidelines 1. The key diagnostic criteria for decompensated liver cirrhosis include:
- Ascites (fluid accumulation in the abdomen)
- Hepatic encephalopathy (brain dysfunction due to liver failure)
- Variceal bleeding (from enlarged veins in the esophagus or stomach)
- Jaundice (yellowing of skin and eyes) These complications indicate that the liver can no longer function adequately, and the patient's condition has progressed to a more severe stage. According to the latest guidelines 1, patients with decompensated cirrhosis should be managed in an institution that can respond appropriately to complications and are candidates for liver transplantation. The Child-Pugh score and MELD (Model for End-Stage Liver Disease) score are commonly used to assess the severity of decompensation, with higher scores indicating worse prognosis, as noted in earlier studies 1. Early recognition of these signs is crucial as decompensated cirrhosis has a significantly worse prognosis than compensated cirrhosis, with a 5-year survival rate of approximately 14-35% without liver transplantation. Management focuses on treating the specific complications and addressing the underlying cause of liver disease, with antiviral therapy being a key component in patients with detectable HBV DNA, as recommended by the latest guidelines 1.
From the Research
Diagnostic Criteria for Decompensated Liver Cirrhosis
The diagnostic criteria for decompensated liver cirrhosis include:
Complications of Decompensated Liver Cirrhosis
Complications of decompensated liver cirrhosis include:
- Spontaneous bacterial peritonitis 3, 4
- Hepatorenal syndrome 2, 3, 4
- Hyponatremia 3
- Hepatic hydrothorax 4
- Portopulmonary hypertension 4
- Hepatopulmonary syndrome 4
Management and Treatment
Management and treatment of decompensated liver cirrhosis involve:
- Treatment of the underlying cause of the disease 5
- Liver transplantation 2, 4, 5
- Artificial liver support devices as a bridging procedure until transplant 4
- Various types of treatment for ascites, such as large-volume paracenteses, cell-free and concentrated ascites reinfusion therapy, transjugular intrahepatic portosystemic shunt, and peritoneo-venous shunt 3