Natural History of Cirrhosis
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LIVER (B BACON, SECTION EDITOR)
Natural History of Cirrhosis Sumeet K. Asrani & Patrick S. Kamath
Published online: 13 January 2013 # Springer Science+Business Media New York 2013
Abstract Significant strides have been made in the last few years in advancing our knowledge of the natural history of cirrhosis. These include (1) a better understanding of prognosis in compensated and decompensated cirrhosis, (2) improved estimates of the natural course of variceal bleeding in patients receiving standard of care therapy, (3) recognition of renal failure and infection as important determinants of mortality in the clinic course, (4) realization of the importance of hepatic venous pressure gradient as a marker of prognosis, progression, and treatment response, and (5) evolution of noninvasive studies of liver stiffness as potential predictors of decompensation. Further studies identifying cirrhotics at highest risk of transitioning from a compensated state to a decompensated state will be important in order to alter the natural history of cirrhosis. Keywords Variceal bleed . Prognosis . Survival . Acute-onchronic liver failure . Hepatic encephalopathy . Prognosis . MELD . HVPG Abbreviations HE Hepatic encephalopathy LT Liver transplantation MELD Model for end stage liver disease INR International normalized ratio GFR Glomerular filtration rate HCC Hepatocellular carcinoma DRI Donor risk index HR Hazard ratio HCV Chronic viral hepatitis C This article is part of the Topical Collection on Liver S. K. Asrani : P. S. Kamath (*) Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA e-mail: [email protected]
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Introduction According to the Centers for Disease Control, chronic liver disease and cirrhosis is the 12th leading cause of death in the U.S. Recent data, however, suggest that it is the eighth leading cause of death overall and the third leading cause of death in persons 45–64 years of age [1, 2]. Mortality related to liver disease over the last 3 decades has, in essence, remained unchanged. Liver disease is also a significant cause of morbidity and accounts for a substantial portion of health-care utilization in the U.S. and worldwide. Understanding the natural history of cirrhosis is important in order to identify patients at highest risk for complications of liver disease. This may permit early intervention and, potentially, alter the clinical course of persons with chronic liver disease toward a favorable outcome. This review discusses the natural history of cirrhosis, as well as updates the reader on recent developments in this field.
Compensated and Decompensated Cirrhosis Cirrhotics are traditionally classified as having compensated and decompensated disease. In a large systematic review, the median survival for persons with compensated cirrhosis was 12 years, and for decompensated cirrhosis 2 years [3]. In a recent Danish population-ba
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