Skip to main content
SpringerLink
Log in

Natural History of Cirrhosis

  • Chapter
  • First Online:
Complications of Cirrhosis

Abstract

Cirrhosis is a dynamic and potentially reversible disease. The natural history of cirrhosis is not the continuum of a single entity but is a progression across different prognostic stages, with the compensated and decompensated stages being the most important. Within the compensated stage, the presence or absence of varices is a key determinant in prognosis. In patients without varices, the main stratifying marker is a hepatic venous pressure gradient of 10 mmHg. Within decompensated cirrhosis, the occurrence of specific complications (ascites, variceal hemorrhage, and encephalopathy) adds to the prognostic granularity of the stage. A stage of “further” decompensation, as defined by the development of refractory ascites, hepatorenal syndrome, recurrent variceal hemorrhage, and recurrent/persistent hepatic encephalopathy, is likely to provide a larger prognostic differential among patients with decompensated cirrhosis. A final stage characterized by multi-organ failure, termed “acute-on-chronic” liver failure, is associated with the worst prognosis. This chapter provides an overview of the various prognostic stages and their significance for patients with cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Garcia-Tsao G, Friedman S, Iredale J, et al. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51:1445–9.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Rosselli M, MacNaughtan J, Jalan R, et al. Beyond scoring: a modern interpretation of disease progression in chronic liver disease. Gut. 2013;62:1234–41.

    Article  PubMed  Google Scholar 

  3. Blasco A, Forns X, Carrion JA, et al. Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation. Hepatology. 2006;43:492–9.

    Article  PubMed  Google Scholar 

  4. Nagula S, Jain D, Groszmann RJ, et al. Histological-hemodynamic correlation in cirrhosis-a histological classification of the severity of cirrhosis. J Hepatol. 2006;44:111–7.

    Article  PubMed  Google Scholar 

  5. Sethasine S, Jain D, Groszmann RJ, et al. Quantitative histological-hemodynamic correlations in cirrhosis. Hepatology. 2012;55:1146–53.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Kumar M, Sakhuja P, Kumar A, et al. Histological subclassification of cirrhosis based on histological-haemodynamic correlation. Aliment Pharmacol Ther. 2008;27:771–9.

    Article  CAS  PubMed  Google Scholar 

  7. Kim MY, Cho MY, Baik SK, et al. Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension. J Hepatol. 2011;55:1004–9.

    Article  PubMed  Google Scholar 

  8. Manne V, Akhtar E, Saab S. Cirrhosis regression in patients with viral Hepatitis B and C: a systematic review. J Clin Gastroenterol. 2014;48(9):e76–84.

    Article  CAS  PubMed  Google Scholar 

  9. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis. A systematic review of 118 studies. J Hepatol. 2006;44:217–31.

    Article  PubMed  Google Scholar 

  10. D’Amico G, Pasta L, Morabito A, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther. 2014;39:1180–93.

    Article  PubMed  Google Scholar 

  11. Ripoll C, Bari K, Garcia-Tsao G. Serum albumin can identify patients with compensated cirrhosis with a good prognosis. Submitted. 2014.

    Google Scholar 

  12. Perello A, Escorsell A, Bru C, et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology. 1999;30:1393–7.

    Article  CAS  PubMed  Google Scholar 

  13. Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254–61.

    Article  CAS  PubMed  Google Scholar 

  14. Garcia-Tsao G, Groszmann RJ, Fisher RL, et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–24.

    Article  CAS  PubMed  Google Scholar 

  15. Bruno S, Zuin M, Crosignani A, et al. Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study. Am J Gastroenterol. 2009;104:1147–58.

    Article  PubMed  Google Scholar 

  16. Zipprich A, Garcia-Tsao G, Rogowski S, et al. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis. Liver Int. 2012;32:1407–14.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133:481–8.

    Article  CAS  PubMed  Google Scholar 

  18. Ripoll C, Groszmann RJ, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50:923–8.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lebrec D, De Fleury P, Rueff B, et al. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980;79:1139–44.

    CAS  PubMed  Google Scholar 

  20. Zipprich A, Seufferlein T, Dollinger MM. Subclinical ascites defines an intermediate stage between compensated and decompensated cirrhosis. Z Gastroenterol. 2012;50:996–1001.

    Article  CAS  PubMed  Google Scholar 

  21. Ferenci P, Lockwood A, Mullen KD, et al. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the Working Party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21.

    Article  PubMed  Google Scholar 

  22. Laleman W, Simon-Talero M, Maleux G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy. Hepatology. 2013;57:2448–57.

    Article  PubMed  Google Scholar 

  23. Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology. 2006;43:S121–31.

    Article  CAS  PubMed  Google Scholar 

  24. Bruno S, Saibeni S, Bagnardi V, et al. Mortality risk according to different clinical characteristics of first episode of liver decompensation in cirrhotic patients: a nationwide, prospective, 3-year follow-up study in Italy. Am J Gastroenterol. 2013;108:1112–22.

    Article  PubMed  Google Scholar 

  25. Garcia-Tsao G, D’Amico G, Abraldes JG, Schepis F, Merli M, Kim WR, et al. Predictive models in portal hypertension. In: de Franchis R, editor. Portal hypertension IV. Proceedings of the Fourth Baveno International Consensus Workshop on Methodology of Diagnosis and Treatment. Oxford: Blackwell; 2006. pp. 47–100.

    Google Scholar 

  26. Wedd J, Bambha KM, Stotts M, et al. Stage of cirrhosis predicts risk of liver related death in low MELD patients with cirrhosis awaiting liver transplant. Liver Transpl. 2014;20(10):1193–201.

    Article  PubMed  Google Scholar 

  27. Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48:2064–77.

    Article  CAS  PubMed  Google Scholar 

  28. Moitinho E, Escorsell A, Bandi JC, et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999;117:626–31.

    Article  CAS  PubMed  Google Scholar 

  29. Abraldes JG, Aracil C, Catalina MV, et al. Value of HVPG predicting 5-day treatment failure in acute variceal bleeding. Comparison with clinical variables. J Hepatol. 2006;44(Suppl 2):S12 (abstract).

    Article  Google Scholar 

  30. Ripoll C, Banares R, Rincon D, et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era. Hepatology. 2005;42:793–801.

    Article  PubMed  Google Scholar 

  31. Salerno F, Borroni G, Moser P, et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993;88:514–9.

    CAS  PubMed  Google Scholar 

  32. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018–26.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Alessandria C, Ozdogan O, Guevara M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41:1282–9.

    Article  PubMed  Google Scholar 

  34. Bajaj JS, O’Leary JG, Reddy KR, et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology. 2014;60(1):250–6. doi:10.1002/hep.27077.

    Article  PubMed  Google Scholar 

  35. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144:1426–37.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Diseases Section, Yale University School of Medicine and VA-CT Healthcare System, 333 Cedar Street—1080 LMP, 06510, New Haven, CT, USA

    Guadalupe Garcia-Tsao MD

Authors
  1. Guadalupe Garcia-Tsao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guadalupe Garcia-Tsao MD .

Editor information

Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA

    Andrew P. Keaveny

  2. Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain

    Andrés Cárdenas

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Garcia-Tsao, G. (2015). Natural History of Cirrhosis. In: Keaveny, A., Cárdenas, A. (eds) Complications of Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13614-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13614-1_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13613-4

  • Online ISBN: 978-3-319-13614-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation