Natural History of Cirrhosis
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.
KeywordsAscites Esophageal varices Hepatic encephalopathy MELD score Portal hypertension Hepatic venous pressure gradient
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