What to know about decompensated cirrhosis

Share on Pinterest

Cirrhosis, including decompensated cirrhosis, usually results from long-term liver disease or damage. The most common causes include:

• Chronic hepatitis B and C: Viral hepatitis, such as hepatitis B and hepatitis C, can lead to chronic liver inflammation. Over time, these viral infections can result in cirrhosis and eventually decompensated cirrhosis.
• Alcohol-related liver disease: Alcohol misuse is a significant contributor to cirrhosis. It can damage liver cells and impair their ability to regenerate, which can lead to cirrhosis, including decompensated cirrhosis.
• Nonalcoholic fatty liver disease (NAFLD): The characteristic feature of NAFLD is the accumulation of fat in the liver. NAFLD can progress to cirrhosis and, subsequently, to decompensated cirrhosis in some cases.

Less common causes of cirrhosis include:

• autoimmune hepatitis, which occurs when the immune system mistakenly attacks the liver
• primary biliary cholangitis, primary sclerosing cholangitis, and other diseases that damage, destroy, or block the bile ducts
• hereditary liver diseases such as hemochromatosis and Wilson’s disease
• use of certain medications for long periods
• chronic heart failure with liver congestion, which is a condition that causes slower blood flow out of the liver

As cirrhosis progresses to its decompensated stage, various symptoms and complications may arise. These include:

• Ascites: This is fluid accumulation in the abdomen, which can lead to abdominal bloating and discomfort.
• Jaundice: This is the yellowing of the skin and eyes due to the impaired ability of the liver to process a yellow substance known as bilirubin.
• Hepatic encephalopathy: This condition involves a decline in brain function due to the liver’s inability to remove toxins from the blood. It may cause confusion and a range of other symptoms.
• Portal hypertension: Scarring can obstruct blood flow through the liver, causing increased pressure in the portal vein, which carries blood to the liver. This may lead to complications such as varices (enlarged veins) that bleed internally and splenomegaly (enlarged spleen).
• Edema: This is swelling due to fluid retention.

People with cirrhosis should contact a healthcare professional if they notice any new symptoms or changes in symptoms.

A person living with decompensated cirrhosis may need a liver transplant. This procedure involves replacing the damaged liver with a healthy one from a donor.

The authors of a 2021 study sought to develop a decompensated cirrhosis discharge bundle (DCDB) to help improve the care of those living with the condition. The DCDB provides healthcare professionals with a checklist to ensure appropriate support for people with decompensated cirrhosis.

Part of the DCDB involves looking at treatments to manage complications and help improve a person’s quality of life. Examples of treatments include:

• Medications: A doctor may prescribe diuretics to manage ascites and reduce fluid retention. Additionally, a person may need a laxative called lactulose or an antibiotic called rifaximin if they are experiencing hepatic encephalopathy. Healthcare professionals may also prescribe medications to treat underlying conditions such as hepatitis.
• Transjugular intrahepatic portosystemic shunt (TIPS): In this procedure, a doctor creates a channel between the portal vein and the hepatic vein. This can help manage portal hypertension.
• Endoscopic band ligation (EBL): During an endoscopy, a doctor inserts a tube into a person’s body to observe an internal organ or tissue. A doctor may notice varices in the esophagus during an endoscopy and can treat them at the same time using EBL, which involves placing elastic bands around the varices to prevent bleeding.
• Lifestyle changes: A doctor may also recommend a changing a person’s diet, completely stopping alcohol consumption, and making efforts to maintain a moderate weight.

People should speak with their doctor, who can recommend appropriate individualized treatments.

Decompensated cirrhosis has a high mortality rate. Research suggests that decompensated cirrhosis has a mortality rate of 85% within 5 years if people do not receive a liver transplant.

To determine the outlook, healthcare professionals may use the model for end stage liver disease (MELD) score. This helps predict the 90-day survival rate for people living with advanced cirrhosis.

A person will need to undergo 3 blood tests to receive a MELD score:

• International normalized ration (INR), which checks the tendency of a person’s blood to clot
• Bilirubin, which checks the amount of bile pigment in the blood
• Creatinine, which checks kidney function

Typically, MELD scores have a range of 6–40. A score of 6 indicates the best chance that a person will survive the next 90 days.

Learn more about life expectancy for cirrhosis of the liver.

If a person has a formal diagnosis of decompensated cirrhosis or suspects they may have the condition, they should have regular contact with a healthcare professional.

Additionally, a person may want to seek help from a healthcare professional if they notice new or worsening symptoms of cirrhosis, such as:

• any signs of internal bleeding, such as vomiting blood or passing black, tarry stools
• shortness of breath
• fever
• any noticeable change in mental function, such as confusion, forgetfulness, or drowsiness
• abdominal bloating or pain

A person with compensated cirrhosis can speak with their doctor about how to manage the condition and prevent it from worsening or progressing to decompensated cirrhosis.

Healthcare professionals may diagnose decompensated cirrhosis when a person’s liver stops functioning properly as a result of chronic liver disease or damage. This condition can cause symptoms and complications such as ascites, portal hypertension, and jaundice.

Treatment focuses on managing complications and preventing further damage. Treatment options may include medications, TIPS insertion, and liver transplantation in severe cases.

Because decompensated cirrhosis has a high risk of mortality, it is important for a person living with the condition to receive prompt treatment. It is also advisable for them to have regular contact with healthcare professionals and to report any new or worsening symptoms.