Cirrhosis natural history, complications and prognosis

Jump to navigation Jump to search

Cirrhosis Microchapters


Patient Information


Historical Perspective




Differentiating Cirrhosis from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray



Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Cirrhosis natural history, complications and prognosis On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Cirrhosis natural history, complications and prognosis

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cirrhosis natural history, complications and prognosis

CDC on Cirrhosis natural history, complications and prognosis

Cirrhosis natural history, complications and prognosis in the news

Blogs on Cirrhosis natural history, complications and prognosis

Directions to Hospitals Treating Cirrhosis

Risk calculators and risk factors for Cirrhosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]


Cirrhosis is an irreversible process, the course of which is highly variable in patients. The natural history progresses in such a way that there is a lengthy stage of compensation, followed by the development of complications and sequelae as a result of the cirrhosis. The devastating complications include complete liver failure or the development of hepatocellular carcinoma. Other complications include portal hypertension, ascites, jaundice, itching, esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome and cardiomyopathy. Prognosis depends on the causes, existing complications and a variety of factors which make the prediction of life expectancy questionable. There are scores that classify disease severity and help to determine suitability for liver transplantation in patients.

Natural history

Decompensated cirrhosis

In patients with stable cirrhosis, decompensation may occur due to various causes:



Well-Compensated, no alcohol 35% mortality at 2 years
Onset of Ascites 50% mortality at 2 years
Variceal bleeding 65% mortality at 1 year (35% short-term mortality)

Poor prognostic factors

Scoring systems

Important scoring systems used are as follows:[27][28]


  1. Sajja KC, Mohan DP, Rockey DC (2014). "Age and ethnicity in cirrhosis". J. Investig. Med. 62 (7): 920–6. doi:10.1097/JIM.0000000000000106. PMC 4172494. PMID 25203153.
  2. 2.0 2.1 Williams EJ, Iredale JP (1998). "Liver cirrhosis". Postgrad Med J. 74 (870): 193–202. PMC 2360862. PMID 9683971.
  3. Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
  4. 4.0 4.1 Lindenmeyer CC, McCullough AJ (2018). "The Natural History of Nonalcoholic Fatty Liver Disease-An Evolving View". Clin Liver Dis. 22 (1): 11–21. doi:10.1016/j.cld.2017.08.003. PMID 29128051.
  5. Bloom S, Kemp W, Lubel J (2015). "Portal hypertension: pathophysiology, diagnosis and management". Intern Med J. 45 (1): 16–26. doi:10.1111/imj.12590. PMID 25230084.
  6. Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J (1996). "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club". Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.
  7. Wilkinson SP, Moore KP, Arroyo V (1991). "Pathogenesis of ascites and hepatorenal syndrome". Gut. Suppl: S12–7. PMC 1405222. PMID 1833293.
  8. Epstein M (1992). "The hepatorenal syndrome--newer perspectives". N. Engl. J. Med. 327 (25): 1810–1. doi:10.1056/NEJM199212173272509. PMID 1435935.
  9. Ginès P, Guevara M, Arroyo V, Rodés J (2003). "Hepatorenal syndrome". Lancet. 362 (9398): 1819–27. doi:10.1016/S0140-6736(03)14903-3. PMID 14654322.
  10. Llovet JM, Burroughs A, Bruix J (2003). "Hepatocellular carcinoma". Lancet. 362 (9399): 1907–17. doi:10.1016/S0140-6736(03)14964-1. PMID 14667750.
  11. García-Criado A, Castellón D (2017). "Presentation of the series "Cirrhosis of the liver and its complications"". Radiologia. doi:10.1016/j.rx.2017.10.003. PMID 29169606.
  12. "Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis - Garcia-Tsao - 2007 - Hepatology - Wiley Online Library".
  13. Wanless IR, Wong F, Blendis LM, Greig P, Heathcote EJ, Levy G (1995). "Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension". Hepatology. 21 (5): 1238–47. PMID 7737629.
  14. Butterworth RF (2000). "Complications of cirrhosis III. Hepatic encephalopathy". J. Hepatol. 32 (1 Suppl): 171–80. PMID 10728803.
  15. Riordan SM, Williams R (2006). "The intestinal flora and bacterial infection in cirrhosis". J. Hepatol. 45 (5): 744–57. doi:10.1016/j.jhep.2006.08.001. PMID 16979776.
  16. Papatheodoridis GV, Patch D, Webster GJ, Brooker J, Barnes E, Burroughs AK (1999). "Infection and hemostasis in decompensated cirrhosis: a prospective study using thrombelastography". Hepatology. 29 (4): 1085–90. doi:10.1002/hep.510290437. PMID 10094951.
  17. Fede G, D'Amico G, Arvaniti V, Tsochatzis E, Germani G, Georgiadis D, Morabito A, Burroughs AK (2012). "Renal failure and cirrhosis: a systematic review of mortality and prognosis". J. Hepatol. 56 (4): 810–8. doi:10.1016/j.jhep.2011.10.016. PMID 22173162.
  18. Arguedas MR, Abrams GA, Krowka MJ, Fallon MB (2003). "Prospective evaluation of outcomes and predictors of mortality in patients with hepatopulmonary syndrome undergoing liver transplantation". Hepatology. 37 (1): 192–7. doi:10.1053/jhep.2003.50023. PMID 12500204.
  19. Fallon MB (2005). "Mechanisms of pulmonary vascular complications of liver disease: hepatopulmonary syndrome". J. Clin. Gastroenterol. 39 (4 Suppl 2): S138–42. PMID 15758649.
  20. Naeije R (2003). "Hepatopulmonary syndrome and portopulmonary hypertension". Swiss Med Wkly. 133 (11–12): 163–9. PMID 12715285.
  21. 21.0 21.1 Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004;24:861-80. PMID 15516683.
  22. Blendis L, Wong F (2003). "Portopulmonary hypertension: an increasingly important complication of cirrhosis". Gastroenterology. 125 (2): 622–4. PMID 12891571.
  23. Gaskari SA, Honar H, Lee SS (2006). "Therapy insight: Cirrhotic cardiomyopathy". Nat Clin Pract Gastroenterol Hepatol. 3 (6): 329–37. doi:10.1038/ncpgasthep0498. PMID 16741552.
  24. Chu CM, Chang KY, Liaw YF (1995). "Prevalence and prognostic significance of bacterascites in cirrhosis with ascites". Dig. Dis. Sci. 40 (3): 561–5. PMID 7895544.
  25. D'Amico G, Garcia-Tsao G, Pagliaro L (2006). "Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies". J. Hepatol. 44 (1): 217–31. doi:10.1016/j.jhep.2005.10.013. PMID 16298014.
  26. Sorensen HT, Thulstrup AM, Mellemkjar L, Jepsen P, Christensen E, Olsen JH, Vilstrup H. Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol2003;56:88-93. PMID 12589875.
  27. Infante-Rivard C, Esnaola S, Villeneuve JP (1987). "Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics". Hepatology. 7 (4): 660–4. PMID 3610046.
  28. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR (2001). "A model to predict survival in patients with end-stage liver disease". Hepatology. 33 (2): 464–70. doi:10.1053/jhep.2001.22172. PMID 11172350.
  29. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R (2003). "Model for end-stage liver disease (MELD) and allocation of donor livers". Gastroenterology. 124 (1): 91–6. doi:10.1053/gast.2003.50016. PMID 12512033.
  30. Wiesner RH (2005). "Evidence-based evolution of the MELD/PELD liver allocation policy". Liver Transpl. 11 (3): 261–3. doi:10.1002/lt.20362. PMID 15719393.
  31. Huo TI, Wu JC, Lin HC, Lee FY, Hou MC, Lee PC, Chang FY, Lee SD (2005). "Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score". J. Hepatol. 42 (6): 826–32. doi:10.1016/j.jhep.2005.01.019. PMID 15885353.
  32. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the esophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-9. PMID 4541913.

Template:WH Template:WS