Cirrhosis and Portal Hypertension: Staging and Prognosis

  • Guadalupe Garcia-TsaoEmail author


Cirrhosis is a dynamic and potentially reversible disease that progresses across different stages that are not only of prognostic significance but that have distinct predominant pathophysiological mechanisms that would, in many cases, necessitate different therapies. The compensated and decompensated stages are the most important stages and it is essential that they be analyzed, described and treated separately both clinically and in research studies. Within the compensated stage, the presence or absence of clinically significant portal hypertension (defined as an hepatic venous pressure gradient of 10 mmHg or higher) is a key determinant in the development of gastroesophageal varices and decompensation. In patients with clinically significant portal hypertension, the absence or presence of varices is a stratifying factor. Within the decompensated stage (defined by the presence of clinically overt complications (ascites, variceal hemorrhage and hepatic encephalopathy), the type and quantity of decompensating events adds to the prognostic granularity of the stage. A stage of “further” or late decompensation (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.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA
  2. 2.Digestive Diseases SectionVA-CT Healthcare SystemWest HavenUSA

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