From the Guidelines
Decompensated cirrhosis is defined as a clinical condition characterized by the development of overt clinical signs, such as ascites, bleeding, encephalopathy, and jaundice, marking the progression from a compensated to a decompensated phase of the disease.
Key Characteristics of Decompensated Cirrhosis
- Marked by the development of overt clinical signs, including:
- Ascites
- Bleeding
- Encephalopathy
- Jaundice
- Characterized by a more rapid progression towards death or liver transplantation compared to compensated cirrhosis 1
- May be further accelerated by the development of other complications, such as rebleeding, acute kidney injury, and bacterial infections 1
Clinical Stages of Cirrhosis
- Compensated cirrhosis: a clinical condition with no overt clinical complications of cirrhosis, and a good quality of life 1
- Decompensated cirrhosis: a clinical condition characterized by the presence of overt clinical complications of cirrhosis, such as ascites, bleeding, encephalopathy, and jaundice 1
Substaging of Decompensated Cirrhosis
- Unstable decompensated cirrhosis: characterized by recurrent episodes of acute decompensation 1
- Stable decompensated cirrhosis: the clinical state achieved after the first episode of acute decompensation, characterized by the persistence of a given clinical condition without worsening of ascites, bacterial infection, hepatic encephalopathy, or portal hypertensive bleeding 1
From the Research
Definition of Decompensated Cirrhosis
Decompensated cirrhosis is characterized by the occurrence of clinical complications, such as:
- Ascites
- Hepatic encephalopathy
- Gastrointestinal bleeding
- Jaundice These complications mark the transition from the compensated to the decompensated stage of cirrhosis 2, 3.
Pathways of Decompensation
Decompensation of cirrhosis can occur through two distinct pathways:
- Non-acute decompensation: a slow development of complications, often presented at first decompensation and/or in patients in an earlier stage of chronic liver disease 2, 3
- Acute decompensation: a sudden onset of complications, which can lead to acute-on-chronic liver failure, a syndrome with high short-term mortality 3, 4
Clinical Course and Survival
The clinical course and survival of patients with decompensated cirrhosis can vary depending on the time of decompensation, with worse survival seen when decompensation occurs later during the course of the disease 5. The pathomechanisms involved in decompensation and disease progression are complex and involve portal hypertension, circulatory dysfunction, inflammation, metabolism, and mitochondrial dysfunction 6.